Add on dexmedetomidine to epidural bupivacaine effective for postoperative analgesia in lower limb orthopedic surgery

According to a recent study published in BMC Anesthesiology, the addition of either nalbuphine or dexmedetomidine to epidural bupivacaine showed effectiveness in managing postoperative analgesia pertaining to onset, duration, and patient satisfaction with the superiority of dexmedetomidine over nalbuphine.

The present study compared adding either nalbuphine or dexmedetomidine to epidural bupivacaine for postoperative pain relief after lower limb orthopaedic surgery, which was performed under combined spinal-epidural anaesthesia.

This study had 69 patients undergoing lower limb orthopedic surgery. Each patient received 15 mg of hyperbaric bupivacaine 0.5% intrathecally for anesthesia. When sensory regression reached T10, an epidural bolus of 12 ml was administered (10 ml of 0.25% bupivacaine with 2 ml of normal saline) in group C, 2 ml of nalbuphine in group N, or 2 ml of dexmedetomidine in group D. Postoperatively epidural top-up doses of 8 ml were given if VAS was ≥3 in group C, 2 ml of nalbuphine in group N, or 20 µg of dexmedetomidine in group D. The study objective was to assess the duration of postoperative analgesia, while secondary outcomes included (side effects and patient satisfaction).

Adding nalbuphine or dexmedetomidine to epidural bupivacaine provided effective postoperative analgesia. Dexmedetomidine offered faster onset, longer duration of analgesia, fewer side effects, and higher patient satisfaction, making it a better option compared to nalbuphine for postoperative analgesia in patients undergoing lower limb orthopaedic surgeries.

The study limitations include a small sample size of patients and a lack of information on available comparisons of equipotent dosing of epidural nalbuphine versus dexmedetomidine.

Reference:

Farmawy, M.S.E., Mowafy, S.M.S. & Wahdan, R.A. Epidural nalbuphine versus dexmedetomidine as adjuvants to bupivacaine in lower limb orthopedic surgeries for postoperative analgesia: a randomized controlled trial. BMC Anesthesiol 23, 401 (2023). https://doi.org/10.1186/s12871-023-02348-x