Background: Optimal pain control following surgery plays a vital role in promoting faster recovery. This research explores the effectiveness of adding dexmedetomidine to hyperbaric bupivacaine in enhancing postoperative analgesia for patients undergoing emergency open appendectomy under spinal anesthesia.

Methods: In this prospective, randomized, double-blind study, 69 patients aged 18 to 65 years were divided into 3 groups: Group 1 received 14 mg bupivacaine and saline; Group 2 received 14 mg bupivacaine with 2 mcg dexmedetomidine; and Group 3 received 14 mg bupivacaine with 4 mcg dexmedetomidine. Demographic parameters and time to first pain onset were assessed, along with hemodynamic stability and adverse effects.

Results: Groups 2 and 3 experienced a significantly delayed onset of postoperative pain, with mean times of 259.43 ± 61.10 minutes and 454.65 ± 80.57 minutes respectively, compared to 154.04 ± 35.12 minutes in Group 1. While overall hemodynamic stability was maintained among all groups, Group 3 showed a marked reduction in both HR and blood pressure. The occurrence of hypotension and bradycardia was comparable across all groups, but nausea was more commonly reported in Group 3. Importantly, no cases of respiratory depression were identified. Additionally, the use of dexmedetomidine had no effect on the extent of sensory or motor blockade, indicating that its administration does not alter the spread of the subarachnoid anesthetic.

Conclusion: When used alongside hyperbaric bupivacaine, dexmedetomidine markedly extends the duration of postoperative pain relief without compromising overall hemodynamic stability, though vigilant monitoring remains essential. Continued investigation into different dosing strategies and drug combinations is necessary to optimize both effectiveness and safety.