Comparison of Ropivacaine with Fentanyl versus Ropivacaine with Dexmedetomidine for Epidural Analgesia in Postoperative Pain Management Following Total Knee Replacement Surgery (Code-T0139)

Introduction: Total knee replacement (TKR) surgery, performed to alleviate severe osteoarthritis, necessitates effective postoperative pain management to enhance recovery, enable early mobilization, and reduce complications. Epidural analgesia, commonly involving ropivacaine, is often combined with adjuvants such as fentanyl or dexmedetomidine to optimize pain relief while minimizing side effects. This study evaluates and compares the efficacy and safety of ropivacaine combined with fentanyl (R+F) versus ropivacaine with dexmedetomidine (R+D) for postoperative pain management.

Aim and Objectives:

Aim

To compare the epidural infusion of ropivacaine and fentanyl versus ropivacaine and dexmedetomidine in patients undergoing total knee replacement surgery for post-operative pain relief.

Objectives

1. To compare the effectiveness of epidural infusion of ropivacaine and fentanyl versus ropivacaine and dexmedetomidine in patients undergoing total knee replacement surgery for post- operative pain relief by comparison of daily mean visual analog scale (VAS) pain scores at various periods of follow up .
2. To compare the effectiveness in terms of requirement of rescue analgesia between the groups at various periods of follow up
3. To compare the rate of complications between the groups at various periods of follow up

Methods: A randomized controlled trial was conducted on 84 patients undergoing TKR. Participants were divided equally into two groups: R+F and R+D. Epidural infusion was administered via elastomeric pumps, and outcomes were assessed through VAS scores, complications, and analgesia requirements.

Results: Both groups demonstrated effective pain relief with similar VAS scores. The R+D group exhibited a higher incidence of complications, including hypotension (14.29%) compared to the R+F group (4.76%). Heart rate and mean arterial pressure were slightly higher in the R+F group but remained clinically insignificant.

Conclusion: Both combinations provided comparable pain relief; however, R+D was associated with a higher complication rate, warranting caution in its use. Further large-scale studies are necessary to refine dosing and optimize patient outcomes.

Keywords: Total Knee Replacement, Epidural Analgesia, Ropivacaine, Fentanyl, Dexmedetomidine, Postoperative Pain