الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Following getting approval of the institutional ethical committee at El-Minia University Hospital, and upon obtaining written informed consent, a total of 60 male and female patients within the age range of 18 to 60 years, belonging to the American Society of Anesthesiologists (ASA) class I to II, will be recruited. These patients will be undergoing lower limb surgery under spinal anesthesia, during the period spanning from February 2022 to September 2023. Prior to determining the protocols, a comprehensive assessment was conducted on all patients to examine their systemic illnesses, hematological characteristics, and coagulation profiles.
The objective of this study was to evaluate and compare the clinical outcomes resulting from the addition of fentanyl (25 μg) versus dexmedetomidine (10 μg) to intrathecal administration of 3 ml of 0.5% hyperbaric bupivacaine in patients having lower limb operations. By conducting a comparative analysis, this study aims to assess many parameters including anesthesia duration, intraoperative and postoperative Visual Analog Scale (VAS) scores, initial analgesic requirement, and total analgesic requirement within the first 24 hours after surgery.
The Patients were assigned to three separate groups of equal size, with 20 patients in each group. The allocation was performed randomly using a computer-generated table.
In group I, consisting of the C group, a combination of bupivacaine and normal saline (BS) was administered to a total of 20 patients. Each Patient received 3 mL of 0.5% hyperbaric bupivacaine along with an additional 0.5 mL of normal saline.
In group II, consisting of the F group, a combination of bupivacaine and Fentanyl (BF) was administered to a total of 20 patients. Each patient received a dosage of 3 ml of 0.5% hyperbaric bupivacaine along with fentanyl at a concentration of 25 μg.
In group III, also referred to as the D group, a combination of bupivacaine and Dexmedetomidine (BD) was administered to a total of 20 patients. Each patient received a dosage of 3 ml of 0.5% hyperbaric bupivacaine along with dexmedetomidine at a concentration of 10μg.
All patients were assessed in terms oF:
A) Intraoperative:
*Time of anesthesia duration
*Heart rate , systolic , diastolic blood pressure, main arterial blood pressure and oxygen saturation were recorded immediately before and after spinal anesthesia and at 5,10,20,30,40,50,60,70 min. ,and then every 15 min. until the end of the operation.
*Visual analogue scale
B) Postoperative:
”HR, MAP and SaO2 at 1, 2, 4, 6, 8, 12, 16, 20, 24 hour post-operative.
*Visual analogue scale at 1, 2, 4, 6, 8, 12, 16, 20, 24 hour post-operative.
*Time of first analgesic request.
*Total analgesic requirement
*Incidence of any side effect.
Time of discharge from recovery room.
Our results recorded that the patient characteristics age, gender, BMI, ASA classification and surgical duration were comparable between three studied groups.
Adjunct dose of dexmedetomidine significantly enhanced onset and duration of block, prolong anesthesia duration,stabilized vital signs ,besides it decreased post operative pain, post operative ketolac requirement and the incidence of PONV compared to addition of fentanyl to bupivacaine or bupivacaine alone.