Comparative Study between Dexmedetomidine Infusion Combination with Ketamine versus Fentanyl for Analgesia for Positioning of Spinal Anesthesia in Elderly Patients with Proximal Femoral Fracture
Authors: Abdelhamid Amr Essam Eldin , Rabia Amal Hamed , Abdelsattar Yasmin Hassan , Elhusseiny Nancy Shaker Shaker 
Published: August 2023

Abstract

Background
One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Spinal anesthesia is preferred in anesthesia of fracture femur surgeries. But the problem is positioning of the patient for spinal anesthesia as the patient is in agony and pain. In our study we chose dexmedetomidine for this goal. We preferred to add an adjuvant to limit side effects of dexmedetomidine and to control pain beside sedation. 70 patients with proximal femoral fracture were blinded and randomized divided into two groups dexmedetomidine ketamine (k) and dexmedetomidine fentanyl (f) each group has 45 patients. There is significant better analgesic effect and sedation of k group than f group. But no significant difference on hemodynamics and postoperative complications.

Objective
The objective of this study is to compare the analgesic effect of combination of ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture.

Patients and Methods
We aimed by our study to compare the analgesic effect of combination of (ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture and we applied our study on 70 patients will be divided into two equal groups: Group k: will receive 1mg/kg of intravenous ketamine with loading dose of dexmedetomidine 1 μg/kg over 10 minutes and Group F : will recieve 1 μg/kg of intravenous fentanyl with loading dose of dexmedetomidine 1 μg/kg over 10 minutes, with the same inclusion and exclusion criteria. then dexmedetomidine infusion only will continued at 0.6 μg/kg/h for following 20 minutes, and titrated at rate of 0.2 to 0.6 μg/kg/h until the end of surgery.

Results
The results of this study revealed that the pain score in lateral position was significally lower in k group than f group (0-1 vs 2-3); p &lt; 0.001. and pain score during hip flexion was significally lower in k group than f group (0-1 vs 2-3 ) respectively p &lt; 0.001. sedation level was much higher in k group than f group (3-4 vs 2-3) p value 0.023. But both groups shows equivalent effect on hemodynamics after dexmedetomidine administration. hypotension, Bradycardia and desaturation was common i in both groups. Regarding post operative complications no significant difference between both groups while incidence of delirium in k group (17.1%) is higher in comparison to f (11.4%) group but not significally difference.

Conclusion
the combination of dexmedetomidine ketamine is a good choice for analgesia of the pain during spinal anesthesia in elderly with fracture femur but need further assessment for dosage and regimen of administration and for better evaluation of the hemodynamic effects