Context:This study was undertaken in 100 patients scheduled for lower limb orthopaedic surgeries.Aim:The objective of this study was to study the effect of addition of intrathecal fentanyl to bupivacaine clonidine mixture on the quality of subarachnoid block and compare it with intrathecal bupivacaine clonidine mixture without fentanyl.Settings and Design:In this prospective and double blind randomized controlled study, one hundred patients, between 20-40 years of age, of either sex, weighing between 40-65 Kg, measuring more than 150 cm in height, of ASA Grade I and II who were undergoing orthopaedic lower limb surgeries were selected in order to study the quality of subarachnoid block and post-operative analgesia produced by a combination of bupivacaine clonidine and fentanyl in comparison with bupivacaine clonidine.Materials and Methods:The patients were randomly divided in two groups of 50 each: Group BC: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 μg) clonidine + 0.4 ml of 0.9% NaCl. Group BCF: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 μg) clonidine + 0.4 ml (20 μg) of fentanyl. The total volume of solution in both the groups was 3.0 ml. The quality of subarachnoid block and post-operative analgesia were studied.Statistical Analysis Used:The data thus obtained was statistically analysed using the following tests: Unpaired student's t-test. Average % change in data over baseline values to detect trends. A ‘P’ value of <0.05 was considered to be statistically significant.Results:There was no significant difference in duration of sensory and motor blockade in group BCF compared to BC. The duration of analgesia as assessed by, either VAS score of >5 or demand of additional analgesia was > 524.6 ± 32.21 mins in group BC and > 774.4 ± 59.59 mins in group BCF. This prolongation of duration of analgesia in group BCF compared to group BC has statistical significance. Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF.Conclusions:In conclusion, this study has demonstrated that addition of 20 μg fentanyl to intrathecal 30 μg clonidine and 12 mg bupivacaine enhanced the duration of post-operative analgesia with moderately increased sedation and was not associated with hemodynamic instability or other complications.

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BACKGROUND Rapid sequence induction is performed in patients at risk of aspiration with a short onset muscle relaxant which reduces the time of gastric insufflation before surgery, along with helping in the rapid control of the airway with adequate intubating conditions. Succinylcholine has been most commonly used, alternatively replaced by rocuronium (non-depolarizing muscle relaxant) which has a similar onset of action of one minute. However, succinylcholine cannot be used in all patients because of its various side effects, and rocuronium isn't available in all centres; in addition to requiring the use of TOF monitoring for muscle paralysis and reversal of the drug. Vecuronium is an intermediate acting non-depolarizing muscle relaxant, with cardio-stable properties, more economical than rocuronium, with an equal potency and in previous studies has been used at a single higher dose to intubate patients in one minute of administration. METHODS A prospective randomized comparative study was conducted in 100 patients scheduled for surgeries under general anaesthesia in the emergency and routine hours of American Society of Anaesthesiologist physical status I and II patients and was divided into two groups of 50 each. Group A received Inj. Vecuronium (0.3 mg/kg) and Group B received Inj. Rocuronium (1.2 mg/Kg) administered as the muscle relaxant after intravenous induction, and the patients were intubated at one minute. Vitals and TOF monitoring were done from preinduction up to 5 minutes after intubation. Intubating conditions were compared using an intubation score, and haemodynamic stability and any side effects were noted along with any significant delay in reversal of the patient at the end of the surgery. Student t test was utilized to compare demographic data, hemodynamic variables and ANOVA was used to evaluate the intubation condition scores and the TOF ratios at 0-and 1-minute intervals. RESULTS The intubating conditions were found favourable and similar in both groups, and TOF values at 1 minute were also similar. Haemodynamic variables were comparable in both groups and no significant side effects were found in either group. CONCLUSIONS Vecuronium can be used as a muscle relaxant for rapid sequence intubations.