A comparative study of hyperbaric bupivacaine versus hyperbaric bupivacaine and fentanyl (12.5 mcg) in subarachnoid anesthesia for lower abdominal and lower extremity surgeries

Abstract

INTRODUCTIONSpinal anesthesia is a safe, convenient and economical form of regional anesthesia technique. It results in sympathetic blockade, sensory analgesia, and motor blockade depending on the dose, concentration or volume of local anesthetic agent administered.1 Bupivacaine is the most common local anesthetic agent used. The desired effect is to block the transmission of nerve signals to and from the affected area. Spinal anesthesia has many advantages over general anesthesia which makes it the anesthesia of choice in the present surgical practice. Its advantages include: 3 Profound muscle relaxation, decreased intra-operative blood loss, preferable in patients suffering from respiratory diseases, early return of gastrointestinal function after surgery, suppress the neuroendocrine response to surgery, better analgesia than parenteral opioids in the postoperative period, reduce perioperative ABSTRACT Background: This study evaluated the effects of adding Fentanyl 12.5 mcg to hyperbaric Bupivacaine 0.5% for spinal anesthesia with regards to the onset of sensory block, maximum sensory level reached and the time to achieve it, time to two dermatome segment regression, onset of motor block, time for maximum motor blockade, duration of motor block, hemodynamic parameters and incidence of side effects. Methods: Sixty patients, male and female, ASA I or ASA II, aged 18 to 65 years scheduled for elective lower abdominal and lower extremity surgeries were randomized into two groups. Group C (Control group) received 0.5% hyperbaric bupivacaine 13 mg (2.6 ml) and Group S (Study group) received 0.5% hyperbaric bupivacaine 13 mg (2.6 ml) and 12.5 mcg of fentanyl (0.25 ml). Intraoperatively, sensory parameters were assessed by pin-prick method and motor parameters were assessed by modified Bromage scale at different time intervals. Haemodynamic parameters were monitored and side effects were also observed. Results: Both groups were comparable with respect to age, height, weight and duration of surgery. There was statistically significant difference with regard to the onset of sensory block, maximum dermatome level, time to achieve it and time to two segment regression between the two groups. Motor parameters did not differ. Conclusions: It was concluded that the addition of 12.5 mcg Fentanyl to 13 mg of hyperbaric Bupivacaine 0.5% for spinal anesthesia significantly decreases the onset of sensory block, enhances the maximum dermatome level and also prolongs the time to segment regression with better hemodynamic stability.

Impacts of intrathecal fentanyl on the incidence of postoperative nausea/vomiting: Systematic review and meta-analysis of randomized studies

“…It has been shown that the addition of 25 μg of fentanyl to 10 mg of 0.5% HB significantly prolonged the duration of complete analgesia, as well as effective analgesia, thus reducing the need for an early use of postoperative analgesics without an increase in adverse effects due to administration of fentanyl in spinal anesthesia during these type of surgeries. [ 25 26 ]…”

“…Several studies have shown the synergism and efficacy of opioid and local anesthetics when used in combination, for the control of PONV. Although in some cases, medication alone appears to be similar in efficacy when used as individual agents; [ 23 26 27 ]the addition of opioids such as fentanyl to HB in spinal anesthesia reduces latency, significantly prolongs duration and improves the efficacy of analgesia, when compared to bupivacaine alone. [ 28 ] Being an opioid, Fentanyl exerts its effects when combined with opioid receptors in the dorsal horn of the spinal cord and may have supraspinal action and propagation.…”

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

“…The desired effect is to block the transmission of nerve signals to and from the affected area. 1 The increasing acceptance of subarachnoid block can be attributed to the simplicity of the technique and equipment, economy, maintenance of consciousness and spontaneous respiration, muscle relaxation, minimal disturbances of body chemistry, less intra operative bleeding, decreased incidence of post-operative nausea, vomiting and aspiration, prolonged post-operative analgesia and a pleasant recovery from anaesthesia. 2 However, these advantages are oppressed by limited duration of action of subarachnoid block and by uncomfortable postoperative period when its action wears off.…”