الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The simplicity of the technique of spinal anaesthesia and its reliability has made it one of the preferred techniques in lower abdominal and lower limb surgeries. Unexpected early regression of spinal block or prolonged operation can cause intraoperative pain. Increasing the dose of local anaesthetics, addition of opioids to local anaesthetics for spinal anaesthesia would be helpful for prolonging the spinal blockade but may cause haemodynamic instability, nausea, urinary retention, respiratory depression and delayed recovery from motor block. Therefore emerged the need for new adjuvants to the intrathecal local anaethetics.
The aim of the study was to compare the addition of either dexmedetomidine or fentanyl to intrathecal bupivacaine as regards: the onset and duration of sensory and motor block, hemodynamic effects, postoperative analgesia and adverse effects of either drug.
The study was carried out on 60 patients admitted to the Alexandria Main University Hospitals and scheduled for elective lower abdominal or lower limb surgeries. They were divided into three groups:
Group B: Patients received 3ml (15mg) of 0.5% hyperbaric bupivacaine + 0.5ml of normal saline intrathecally.
Group F: Patients received 3ml (15mg) of 0.5% hyperbaric bupivacaine + 0.5ml (25 microgram) of preservative free fentanyl intrathecally.
Group D: Patients received 3ml (15mg) of 0.5% hyperbaric bupivacaine + 0.5ml (5 microgram) of diluted, preservative free dexmedetomidine intrathecally.
Preoperative evaluation was done by complete history taking, physical examination and necessary laboratory investigations.
Patients were premedicated by H2 antagonist. Before commencing regional anaesthesia, standard monitoring was established: ECG for heart rate and rhythm, non-invasive measurement of arterial blood pressure and oxygen saturation.
They were given intravenous lactated Ringer’s solution 10 ml/kg as volume preload. Spinal anesthesia was performed in the sitting position at the L3-4 interspace with midline or paramedian approach by using a 25 gauge Quinke’s spinal needle with all aseptic precautions. Injection was given according to the groups
After injection was given, patients lied supine and low flow oxygen (4L/minute) was administered via oxygen mask.
The following parameters were measured:
• Patient data: 1. Patient’s age (in years). 2. Patient’s height (in cm).
• Duration of the operation: (in minutes).
• Hemodynamic measurements: (measured pre-spinal anaesthesia, intra and post operatively) Heart rate, mean arterial blood pressure and oxygen saturation.
• Sensory assessment: Onset of sensory block, sensory level of analgesia, duration of sensory block and pain assessment postoperatively by evaluation of VAS, time to first request of analgesia and total doses of analgesics within the first 24 hours.
• Motor assessment: Onset of motor block and duration of motor block.
• Side effects: also, were documented intra and post operatively.
As regards the age, heig