Comparison of Dexmedetomidine and Butorphanol as Adjuvants to Levobupivacaine for Epidural Anaesthesia in Hip and Lower Limb Surgeries: A Randomized Controlled Trial

Abstract

Background: Epidural anaesthesia is a useful anaesthetic technique with many applications ranging from analgesia with minimal motor block to dense anaesthesia with full motor block. Adjuvants added to local anaesthetics improve the quality of epidural block and prolong the postoperative analgesia.
Aim: The study was aimed to compare the haemodynamic, sedative, sensory, motor and analgesic properties of dexmedetomidine and butorphanol as adjuvants to 0.5% levobupivacaine in epidural anaesthesia.
Material and Methods: A randomized controlled study was carried out on 90 patients of either sex ranging in the age group between 18 to 60 years belonging to ASA grade I & II, undergoing elective hip and lower limb surgeries under epidural anaesthesia. Patients were randomly allocated to one of the three study groups, each group comprising of 30 patients. Group L received epidural levobupivacaine, Group LD received epidural levobupivacaine with dexmedetomidine and Group LB received epidural levobupivacaine with butorphanol. The haemodynamics, block characteristics, sedation and side effects were observed. The data was analysed using ANOVA test.  Inter group comparisons were made using student´s t-test and Chi square test. Value of p≤0.05 was considered statistically significant.
Results: Time to attain adequate sensory and motor block was faster in group LD in comparison to Group LB and Group L (p<0.0001). Regression to S1 segment, duration of sensory and motor blockade was prolonged in Group LD as compared to Group LB and Group L (p<0.0001). Sedation score was better in Group LD as compared to other groups.
Conclusion: Dexmedetomidine is better adjuvant than butorphanol when added to epidural levobupivacaine in terms of faster onset of sensory and motor block, prolonged post operative analgesia and better sedation.