Dexmedetomidine overrides Fentanyl and Tramadol as Epidural Adjuvant for its advantageous Anesthetic Outcomes and Immunomodulatory effects

Background: Surgical stress is aggravated by anesthesia especially opioid-based anesthesia. Epidural anesthesia (EA) was previously found to modulate the immune response. Bupivacaine (BUP) may suffice as anesthetic but adjuvant might increase this and possibly may modulate the stress response Objectives: Evaluation of the effects of dexmedetomidine (DEX), fentanyl (FEN), or tramadol (TRM) as adjuvants to BUP-EA on anesthetic outcomes and serum levels of interleukin (IL)-6, IL-1β and Tumor necrosis factor-α (TNF - α) during varicose vein surgery. Patients and methods : 120 patients received single-shoot BUP 0.5% EA alone or with 25, 50 and 100 µg of DEX, FEN and TRM, respectively. Blood samples were obtained at start (T1) and end of surgery (T2) and 24-h postoperative (PO) (T3) for ELISA estimations of cytokines' levels. Study outcomes include the effect of adjuvants on anesthetic outcome and serum cytokines. Results : Adjuvants significantly fastened