الفهرس 
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Abstract
This study was performed to compare the sedative and post-operative analgesic effects between dexmedetomidine and morphine as an adjuvants to bupivacaine through epidural root in patients undergoing lower limb orthopedic surgeries.
This study was achieved on 66 patients ASA I and II who were scheduled for lower limb orthopedic surgery. The study included the patients of age group between 18-60years.
Patients were randomly allocated to two equal groups, 33 patients for each group. All patients were given epidural anesthesia then,
group ( DB ) : patients received 15 ml of plain Bupivacaine 0.5 % +100 mcg Dexmedetomidine (n=33) at the rate of 1 ml/second.
group ( MB ): patients received 15 ml of plain Bupivacaine 0.5% +1 mg Morphine(n=33) at the rate of 1 ml/second.
All patients were clinically examined in the preoperative visit, whenwritten informed consent from all the patients above 21 years, while less than 21 years require their parents’ written informed consent and whole procedure was explained. 10 cm visual analogue scale (VAS) (0, no pain and 10, worst pain imaginable) was also explained during preoperative visit. Baselines of patients’ data were recorded as blood pressure, heart rate, respiratory rate and temperature.
On entering the patient in the operative room standard intraoperative monitors like ECG, pulse oximeter, noninvasive blood pressure were attached and baseline parameter were recorded.
The anesthetic technique was standardized for all patients. With aseptic precautions Lumber puncture was done in sitting position at L3 and L4 inter-vertebral space with 18‑gauge Tuohy’s needle.
Clinical outcome assessment was done by depending on the following measurements: - Demographic data, Hemodynamics, characteristics of epidural block , Complication, Pain Scoring (VAS) ,first request of analgesia, total dose consumption of bupivacaine and Sedation (Ramsay Sedation Score ).
Regarding Demographic data, intraoperative and post-operative hemodynamics all did not show any significant difference among the study groups.
Statistically significant difference was noted, regarding onset ofsensory block , group dexmedetomidine showed shorter onset of analgesia( 8.16 ± 1.24) compared to group morphine ( 9.78 ± 1.3).
The study showed significant difference between two groups regarding adverse effects (nausea , vomiting, pruritus ),group dexmedetomidine showed less side effects than group morphine.
The study showed significant difference between two groups regarding sedation score, group dexmedetomidine showed better sedation scores compared to group morphine.
There was no statistically significant difference between the two groups regarding first request of analgesia and total dose consumption of bupivacaine.
This study concluded that the use of dexmedetomidine as an adjuvant to bupivacaine seems to be a good alternative to the use of morphine in epidural anesthesia in lower limb orthopaedic surgeries as