Comparative study of the effect of dexmedetomidine and butorphanol as epidural adjuvants in abdominal hysterectomy under intrathecal levobupivacaine anesthesia

Background: Combined spinal-epidural technique has become increasingly popular in the last few years for abdominal hysterectomies. Opioids or α-2 agonists are being increasingly used as epidural adjuncts. Aims: The aim of this study is to compare the clinical profile of dexmedetomidine and butorphanol when administered epidurally, following intrathecal levobupivacaine (heavy) in combined spinal and epidural anesthesia. Materials and Methods: Sixty adult patients aged 18-60 years, the American Society of Anesthesiologists Physical Status I and II undergoing abdominal hysterectomy were enrolled into the study and randomly divided into two groups: Group LD (n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus dexmedetomidine 1 ΅g/kg in 10 ml saline epidurally and Group LB (n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus butorphanol 10 ΅g/kg in 10 ml saline epidurally. The hemodynamics, block characteristics, and side effects were observed; the data were compiled and analyzed using Student's t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: The demographic profiles of the patients were comparable between the two groups. The onset of sensory analgesia at T10 was significantly faster in the Group LD (92.80 ± 31.51 vs. 105.43 ± 42.04 s). The time to two-segmental regression in dexmedetomidine group was 184.23 ± 45.10 min versus 120.40 ± 33.03 min in butorphanol group (P < 0.001). Postoperative analgesia was prolonged in the Group LD (321.43 ± 60.68 vs. 205.03 ± 57.90 min, P < 0.001). Sedation scores were much better in the LD group and highly significant on statistical comparison (P < 0.001). Conclusions: Dexmedetomidine was a better alternative to butorphanol as an epidural adjuvant providing comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged postoperative analgesia, and much better sedation.