الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
“Epidural anaesthesia” the most versatile and suitable technique of central neural blockade provides excellent pain relief both intraoperatively and postoperatively, with very low incidence of side effect.
The main limitation of local anaesthetics with epidural block is its slower onset of action and requirement of high dose. Here comes the role of an adjuvant. These adjuvant when combined with local anaesthetics increase duration of the block, improve quality of blockade and accelerate onset of block. (107)
The aim of this work was to evaluate the effect of dexmedetomidine versus fentanyl as an adjuvant to epidural bupivacaine in knee arhtroscopic surgeries.
This prospective randomized double blind study was done on forty adult patients American Society of Anaesthesiologists (ASA) class I or II admitted to Al-Hadara University Hospital in Alexandria. After approval of the medical ethical committee, an informed written consent was taken from all patients
According to the drugs used in epidural anaesthesia, patients were categorized into 2 groups (20 patients each) by closed envelop method:
Group BF: Bupivacaine 0.5% (19 ml) +fentanyl (1 μg/kg), total volume 20 ml.
Group BD: Bupivacaine 0.5% (19 ml) +Dexmedetomidine (1 μg/kg), total volume 20 ml.
Preoperative evaluation was done by complete history taking, physical examination and necessary laboratory investigations. In the preoperative visit, patients were instructed on the proper use of the visual analog scale (VAS) for assessing pain (100-point scale). At the operating room, an 18 gauge (G) cannula was inserted in a peripheral vein, and then each patient was attached to a multi-channel monitor to display:
• Continuous Electrocardiography monitoring for heart rate (beat/min) and detection of dysrhythmias (lead ІІ).
• Non invasive arterial blood pressure (NIBP).
• Arterial oxygen saturation (SPO2).
After intravenous access, Preloading with an infusion of ringer’s lactate (15 ml/kg) was done. Oxygen was administered through a face mask (2L/min) for all patients. The epidural space was identified at L2-3 or L3-4 using a loss of resistance technique under strict asepsis, and a 20 gauge (G) epidural catheter was then advanced for 3 to 5 cm into the epidural space. Correct placement of epidural catheter was verified with a test dose of 3 ml epidural lignocaine 2% with adrenaline (1: 2 00,000).