الفهرس 
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Abstract
Epidural anesthesia is the most commonly used technique for inducing surgical anesthesia and postoperative analgesia in lower limb surgeries.
It has been shown to decrease postoperative pain, nausea, vomiting and time to discharge, as well as reducing incidence of deep vein thrombosis, pulmonary embolism, blood transfusion requirement and respiratory depression.
Bupivacaine is commonly used local anesthetic in epidural anesthesia, many adjuvants added to local anesthetics to improve the quality of epidural block and prolong blockade, among them are opioids, alpha 2 agonists, non-opioids like tramadol and neostigmine.
Opioids like fentanyl have been a popular choice, it offers faster onset and prolongs the duration of analgesia. Recently, alpha 2 agonists like clonidine and dexmedetomidine have been also used in prolonging the duration of epidural analgesia.
The main object of this study is to assess and compare the efficacy of using fentanyl and dexmedetomidine with bupivacaine in epidural block for knee surgeries. The time of onset of sensory, motor blockade and the duration of these blockade.
This prospective randomized double blinded study was carried in Ain Shams University hospitals on 50 patients scheduled for knee surgery. Patients were randomized into two groups 25 patients each:
group D: 10 ml of 0.5 % bupivacaine with dexmedetomidine 1 μg/kg (n=25 patients).
group F: 10 ml of 0.5 % bupivacaine with fentanyl 1 μg/kg (n=25 patients).
Comparisons were done between the two groups as regards: onset of sensory and motor block, time for two segment regression, duration of the block, hemodynamics (mean blood pressure and heart rate) also sedation grade and rescue doses among each group.
The current study revealed that epidural dexmedetomidine with bupivacaine is hemodynamically stable, produces a faster onset of sensory and motor blockade, with significantly prolonged blockade duration and lesser requirement of rescue analgesia with higher sedative property compared to fentanyl with bupivacaine in knee surgeries.