Bupivacaine-Sufentanil Versus Bupivacaine-Fentanyl in Spinal Anesthesia of Patients Undergoing Lower Extremity Surgery

Abstract

Background:The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia and prolong the duration of analgesia, when using a subarachnoid block in Iranian patients with their specific pain tolerance.Objectives:The aim of this study was to evaluate the effects of adding fentanyl or sufentanil, to intrathecal bupivacaine, in terms of the onset and duration of; sensory block, motor block, hemodynamic effects and postoperative pain relief.Patients and Methods:This randomized clinical trial included 90 patients who underwent orthopedic lower limb surgeries. Subjects were divided into experimental groups; intrathecal fentanyl 25 µg (F), and sufentanil 2.5 µg (S), along with a placebo 0.5 mL normal saline (C) group, which were added to bupivacaine 0.5%, 15 mg. Duration of complete and effective analgesia was recorded (by a visual analogue scale-VAS). The pain scores were assessed postoperatively. Intraoperative mean arterial pressure (MAP), heart rate and oxygen saturation (SPO2) were recorded. The incidence of side effects such as; nausea, vomiting, pruritus, shivering, bradycardia and hypotension were also recorded.Results:MAP and heart rate results showed no significant changes at the designated time points among the three groups (P > 0.05). However, SPO2 and VAS showed significant changes at the designated time points among the three groups (P < 0.05). The duration of complete and effective analgesia was also significantly longer in the sufentanil group (P < 0.05). Motor block did not exhibit any significant difference (P = 0.67). Only pruritus as a side effect was significantly higher in the sufentanil group (P < 0.05), while all other evaluated side effects were significantly lower in the sufentanil group (P < 0.05).Conclusions:The addition of 2.5-3 mcg sufentanil to 15 mg 0.05% bupivacaine maintained the patient’s hemodynamic stability similar to fentanyl. Intrathecal sufentanil added to bupivacaine,when compared with fentanyl, may lead to prolonged duration of analgesia, facilitate the spread of the sensory block, increase mean SPO2 levels, and reduce overall side effects.

A prospective randomized controlled study comparing intrathecal bupivacaine combined with fentanyl and sufentanil in abdominal and lower limb surgeries

“…30% of patients in sufentanil group reached this level while only 5% in fentanyl group reached this level. [ 7 ] It was comparable to our findings. In another study comparing intrathecal fentanyl and sufentanil for endoscopic urological procedures, it was found that the maximal block height achieved by sufentanil group was (T10-T11) while fentanyl group was (T8-T11), which was significantly lower level achieved than our findings.…”

“…The pain scores were significantly lower with sufentanil group. [ 7 ] The onset of sensory block was delayed in fentanyl and sufentanil group as compared to control group in another study. The difference may be due to the lower dose of bupivacaine used in fentanyl, sufentanil group (5 mg) as against control group (7 mg).…”

“…The reason may be due to a lower dose of sufentanil (2.5 μg) used when compared to our dose (5 μg). [ 7 ]…”

The Effect of Adding Sufentanil to 0.5% Hyperbaric Bupivacaine on Duration of Brachial Plexus Blockade in Chronic Opium Abusers: a Randomized Clinical Trial

“…In more recent studies, it was proposed that adding sufentanil to intrathecal bupivacaine may prolong the duration of analgesia and facilitate the spread of sensory block ( 13 ). Studying patients with a history of drug abuse has its own challenges.…”

Intrathecal Sufentanil Does Not Reduce Shivering During Neuraxial Anesthesia: A Meta-Analysis

“…Sufentanil intrathecal administration can significantly shorten the onset time of anesthesia, improve the analgesic property of intrathecal anesthesia, and prolong the duration of analgesia [ 9 – 13 ]. Hassani et al [ 14 ] found that the effect of the addition of sufentanil to maintain hemodynamic stability was similar to the effect of fentanyl. Intrathecal sufentanil added to bupivacaine, as compared with fentanyl, may prolong duration of analgesia, facilitate the spread of the sensory block, increase mean pulse oximetry levels, and reduce overall adverse effects.…”