The Effects of Dexmedetomidine As an Adjuvant with Levobupivacaine To Epidural Analgesia on The Outcomes of Patients Undergoing Total Abdominal Hysterectomy Surgery

Abstract

Background: Total abdominal hysterectomy (TAH) characterizes as major surgery with increased risk of morbidity. It depends on adequate pain management intra- and postoperatively. Anesthesia management of TAH widely uses a regional approach with the epidural technique which administers a local anesthesia agent into the epidural space.

Objective: This study aims to determine the effectiveness of epidural levobupivacaine with fentanyl versus levobupivacaine with dexmedetomidine for epidural anesthesia in patients undergoing TAH.

Methods: This is a prospective, single-blinded trial conducted among 20 patients aged 18 to 40 years who underwent elective TAH with American Society of Anesthesiologist (ASA) class I and II status. The control group received epidural levobupivacaine 0.5% with fentanyl as an adjuvant, while the dexmedetomidine group received levobupivacaine 0.5% with dexmedetomidine as an adjuvant. We then compared the degree of pain using a numeric rating scale (NRS) 24 hours after surgery, duration of analgesia, and incidence of postoperative nausea and vomiting (PONV) in both groups.

Result: Duration of analgesia was 89.60 + 7.6332 min in group dexmedetomidine, while it was 78.0 + 10.4562 min in group fentanyl, respectively (P < 0.05). The means of NRS was 3.00 + 1.88562 in group dexmedetomidine and 4.80 + 1.1352 in group fentanyl (p=0.019). The incidence of PONV in group dexmedetomidine was three, while in group fentanyl was eight (p=0.025).

Conclusion: Dexmedetomidine is preferred over fentanyl when added to levobupivacaine for epidural analgesia in TAH procedures. Dexmedetomidine offers superior quality with a prolonged duration of analgesia, lower NRS values, and a lower incidence of PONV rather than fentanyl.