Background: Spinal anaesthesia is the preferred technique for lower segment caesarean section (LSCS) due to rapid onset, dense sensory block, and minimal drug exposure to the fetus. Adjuvants such as dexmedetomidine and fentanyl are commonly added to intratheral local anesthetics to enhance the quality and duration of block.

Aim: To compare the efficacy and safety of adding dexmedetomidine versus fentanyl to intrathecal levobupivacaine 0.5% in parturients undergoing LSCS.

Methods: In this prospective, randomized, double-blind study, 50 ASA II parturients were randomly allocated into two groups (n=25 each). Group D received 2.5 ml of 0.5% levobupivacaine with dexmedetomidine 5 μg, while Group F received 2.5 ml of 0.5% levobupivacaine with fentanyl 25 μg. Onset time, duration of sensory and motor block, hemodynamic parameters, and adverse effects were recorded.

Results: Group D showed significantly faster onset of sensory block (2.3±0.5 min) compared to Group F (3.1±0.6 min, p<0.001) and longer duration of sensory block (262±18 min vs. 218±20 min, p<0.001). Duration of motor block was also prolonged in Group D (210±15 min) compared to Group F (175±14 min, p<0.001). Hemodynamic stability was comparable in both groups, with mild bradycardia observed in 2 patients in Group D and pruritus in 4 patients in Group F.

Conclusion: Intrathecal dexmedetomidine with levobupivacaine provides earlier onset and longer duration of sensory and motor block compared to fentanyl, with comparable safety in LSCS.