Comparative Efficacy of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Levobupivacaine versus Ropivacaine in Spinal Anaesthesia: A Randomized Controlled Trial

Abstract

Background and Aims: The selection of optimal local anaesthetic and adjuvant combinations in spinal anaesthesia significantly influences clinical outcomes, particularly regarding block characteristics, hemodynamic stability, and postoperative analgesia. The objective of our study was to compare the efficacy and safety of dexmedetomidine as an adjuvant to intrathecal hyperbaric levobupivacaine versus ropivacaine in adult patients undergoing elective surgery.

Methods: A prospective, randomized, single-blind study was conducted involving 60 adult patients (ASA I-II) scheduled for elective surgeries under spinal anaesthesia. Participants were randomly allocated to receive either levobupivacaine 15 mg plus dexmedetomidine 10 μg (Group L, n=30) or ropivacaine 15 mg plus dexmedetomidine 10 μg (Group R, n=30). Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes encompassed postoperative analgesia duration, hemodynamic parameters, and adverse events.

Results: Onset times for sensory (92.27±12.05 vs 93.57±11.16 seconds, p=0.666) and motor (326.93±19.03 vs 327.60±18.68 seconds, p=0.892) blocks were comparable between groups. Group R demonstrated significantly longer sensory block duration (334.83±18.73 vs 280.17±14.35 minutes, p=0.001) and postoperative analgesia (513.67±35.04 vs 416.50±37.65 minutes, p=0.001). Group L exhibited prolonged motor block duration (117.33±6.23 vs 111.47±5.88 minutes, p=0.001). Hemodynamic stability was maintained in both groups with minimal adverse events. Hypotension occurred in 16.7% of Group L and 20.0% of Group R patients (p=0.739), with no cases of bradycardia or other serious complications.

Conclusions: Both dexmedetomidine combinations provided safe and effective spinal anaesthesia with rapid onset characteristics. Ropivacaine-dexmedetomidine offers superior postoperative analgesia and sensory block duration, making it preferable for procedures requiring extended pain control. Levobupivacaine-dexmedetomidine provides longer motor blockade, suitable for surgeries demanding prolonged immobilization. The choice between combinations should be tailored to specific surgical requirements and patient recovery goals.

Keywords: Dexmedetomidine, Levobupivacaine, Ropivacaine, Spinal anaesthesia, Postoperative analgesia, Regional anaesthesia.