Comparative Evaluation of Dexmedetomidine, Ketamine & their Combination for Epidural Analgesia in Orthopedic Surgeries of the lower Limb

Abstract

Background: Epidural anesthesia is a perioperative pain control treatment that has a variety of applications in anaesthesiology. It could be used as as a primary anaesthetic, although it's most usually utilised as an adjuvant for management of pain.  It could be a one-time shot or a continuous infusion for a long-drawn therapeutic intervention. Apart from the potential for significant analgesia, its use minimises the need for other anaesthetics and analgesics, lowering the risk of adverse effects. It has also been proven to lower the level of cortisol, to facilitate the resumption of bowel function, reduce the risk of Pulmonary embolism and deep vein thrombosis in the post-operative phase, while minimizing the duration of institutional stays. Aim: Comparison and Evaluation of the effect of the drugs dexmedetomidine , ketamine & them together as a combination in addition to bupivacaine, as an adjuvant for intermittent epidural top ups for lower limb orthopaedic surgeries . Study Design: Prospective observational study. Place and duration of Study: The study will be conducted over a period of 2 years and 6 months in the department of anaesthesiology, Jawaharlal Nehru medical college and Acharya vinoba bhave rural hospital, wardha. Methodology: Our prospective, comparitive observational study included 90 patients randomly assigned into 3 sets of 30 each, one was administered dexmedetomidine epidurally, one was given ketamine and one was given their combination epidurally [1]. The quality and duration of analgesia provided by all 3 groups were then compared to find out which of them provides better and prolonged pain relief. Along with analgesia, the other parameters assessed were hemodynamic response, sedation and any other side effects. Expected Results: We're attempting to establish the hypothesis that the combination of both the drugs is better than dexmedetomidine or ketamine administered individually. It has been proved in various researches that epidural ketamine prolonged the duration of analgesia, [2] but it was less than epidural dexmedetomidine. We expect that the combination would decrease the postoperative rescue analgesics requirements and less hemodynamic alterations hence providing greater patient satisfaction as compared to the two drugs separately.