Comparison of dexmedetomidine-fentanyl and dexmedetomidine-pentazocine for monitored anesthesia care during tympanoplasty surgery

Abstract

Background: Several Middle Ear Surgeries have been done under Local or General Anesthesia and it has many advantages. However, there is inability of the patients to tolerate noise of suction, manipulation of instruments, positioning of head-neck, pain etc. Monitored Anesthesia care is a planned procedure for 10-30% of all surgeries. MAC typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs which is a common practice during Tympanoplasty. Methodology: The present study was designed to compare α-2 agonist Dexmedetomidine with intravenous Pentazocine and Fentanyl. The study was approved by institutional ethical committee. 50 patients were registered in this study; patients were randomly allocated into 2 groups (group DF and group DP). Group DF and Group DP received IV Dexmedetomidine at a loading dose of 1mcg/kg over 10 minutes followed by continuous infusion 0.5 mcg/kg/hr till surgery was over. Degree of sedation and pain intensity using Visual analogue scale (VAS) and Ramsay Sedation Score (RSS), Rescue doses of Fentanyl and Pentazocine were observed and noted. P-value was used for statistical analysis. Results: Higher repeated doses of Pentazocine were required for group DP patients (6.25±4.573) as compared to Group DF participants injected with Fentanyl (6±8.287). Surgeon satisfaction score was more satisfactory in Group DF (Fentanyl) than Group DP (Pentazocine). Post-operative Visual Analogue Score (VAS) was higher in group DP (2.18±1.1.8) than group DF (0.593±0.2392). No post-operative complications were seen in both groups. Conclusion: We found that Dexmedetomidine-Fentanyl is a better combination in Tympanoplasty surgeries under monitored anesthesia care. It not only improves the intra-operative analgesia but also gives better post-operative analgesia.