The aim of this study is to compare the analgesic efficacy and safety of dexmedetomidine versus fentanyl as adjuvants to bupivacaine in ultrasound-guided combined supra-inguinal fascia iliaca and proximal sciatic nerve blocks used as a solo anesthetic technique in high-risk patients undergoing unilateral above knee amputation.
- Age ≥18 years
Both sexes
ASA III-IV
Documented cardiac disease (e.g., EF < 40%, NYHA II or higher)
Neurological or intellectual disability
Drug abuse
Allergy to study drugs
Pregnancy
Parallel
Dexmedetomidine
DrugDexmedetomidine added as an adjuvant to the local anesthetic solution during peripheral nerve block for above-knee amputation surgery.
Fentanyl (as Citrate)
DrugFentanyl added as an adjuvant to the local anesthetic solution during peripheral nerve block for above-knee amputation surgery.
Time to the first request for the rescue analgesia
the first time the patient needs analgesia postoperative
Total morphine consumption postoperative.
the total dose of morphine given to the patient in the 24 hours postoperative
Intraoperative Pain score (VAS).
assessment of pain intensity using the visual analogue score (VAS) ranging from 0 to 10 where 0 indicates no pain and 10 indicate the worst pain imaginable , higher scores indicate worse pain
Patient satisfaction
by a scale from 1 to 5 where is 1 is very dissatisfied and 5 is very satisfied higher scores indicate greater patient satisfaction
intraoperative heart rate
measurments of intraoperative HR every 5 mins
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