Evaluation of Dexmedetomidine Co-Administered with Neostigmine and Bupivacaine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries – A Study from Maharashtra, India

BACKGROUND Addition of adjuvants to the neuro axial blocked helps prolongate the duration and quality of analgesia and anaesthesia. The safety and efficacy of drugs dexmedetomidine and neostigmine have been less commonly studied. We wanted to compare post-operative analgesia, haemodynamics, and side effects if any in this study. METHODS Combined spinal - epidural anaesthesia was performed in 60 patients who underwent lower limb surgeries of less than 2 hrs. The patients were given the drug epidurally post-surgery. Group I, II and III were given 10 ml of 0.25 % bupivacaine alone, with 1 microgram per kg of neostigmine and with 0.5 milligram per kg of dexmedetomidine and 1 microgram per kg of neostigmine, respectively. 50 mg tramadol intravenous was kept as rescue analgesic. Parameters which predict haemodynamics, assessment of pain, period of analgesia, demand for rescue analgesia and the chances of side effects were noted over the next ten hrs. RESULTS To conclude, epidural analgesia is the most preferred analgesia these days in management of lower limb orthopaedic surgery’s post-operative pain. When bupivacaine was combined with neostigmine and dexmedetomidine as a neuraxial adjuvant, it prolonged the post-operative analgesia significantly without increasing the side effects of those drugs. The combination of two drugs proved better than the use of single drug alone. CONCLUSIONS Combination of neostigmine and dexmedetomidine when used as a neuraxial adjuvant, significantly prolonged the duration of post-operative analgesia by 274.13 4.539 in lower limb orthopaedic cases compared to neostigmine alone that was 176.23 ± 3.441. KEY WORDS Epidural, Neostigmine, Dexmedetomidine, Orthopaedic Surgeries, Post-Operative Analgesia