Comparison between high dose hyperbaric Bupivacaine (12.5 mg) alone versus low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in spinal anaesthesia for inguinal hernia surgery

Abstract

<p class="abstract"><strong>Background:</strong> For performing inguinal hernia surgeries, giving spinal anesthesia is a well known technique as it easy and provides fast onset, effective sensory and motor blockade in an awake patient. Now-a-days Bupivacaine is gaining importance as an effective spinal anaesthetic agent in combination with opioid analgesic Fentanyl to reduce the postoperative pain and side effects associated with surgery. This study aims to compare the effectiveness of intrathecal Bupivacaine alone versus combination of Bupivacaine with Fentanyl.</p><p class="abstract"><strong>Methods:</strong> The study designed was a prospective, randomized, double blinded comparative study. Patients were randomly divided into two groups of 25 each. Group B received hyperbaric intrathecal Bupivacaine 12.5 mg and Group BF received diluted hyperbaric intrathecal Bupivacaine 7.5 mg and Fentanyl 25 µg for spinal anesthesia . Parameters like sensory and motor block were assessed. Side effects produced during perioperative and postoperative period were observed and noted. Satisfactory criteria by the surgeons and patients were considered.</p><p class="abstract"><strong>Results:</strong> The time taken to attain surgical anesthesia and peak sensory levels in minutes was statistically significant in Group B compared to Group BF. Due to higher dose of Bupivacaine, it was observed that degree of motor blockade is also higher in group B when compared to group BF. The incidence of hypotension, nausea, vomiting and hypothermia are significantly higher in group B due to high dose of Bupivacaine. The surgeons and patients satisfaction was good in both the groups. </p><p><strong>Conclusions:</strong> Low dose Bupivacaine in combination with Fentanyl is safe and effective alternative for spinal anesthesia for inguinal herniorrphaphy as compared to conventional high dose Bupivacaine alone.</p>

A Comparative Study on Three Different Doses of Fentanyl with Bupivacaine in Spinal Anaesthesia in Caesarean Section

“…There were no incidences of vomiting. There was no respiratory depression among the three study groups which was in accordance with the studies of Belzarena et al, 30 Singh et al, 3 Ben David et al 4 and Kotwani et al 31 Itching was significantly seen in patients receiving 25mcg of fentanyl (p value<0.05) which was also seen in the study conducted by Hunt et al, 1 Belzarena et al, 30 Ali et al 11 The incidence of side effects except hypotension were more commonly seen in group using 25 mcg of fentanyl. The strength of the study is that this study is one of the few studies which compared the effect of three doses (15 mcg, 20 mcg, 25 mcg) of fentanyl as an adjuvant with bupivacaine heavy (7.5 mg) as local anaesthetic during spinal anaesthesia for caesarean section.…”

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

“…Majority of researchers have reported incidence ranging from 0%-35% in low dose group and higher incidence of 41% in patients where higher dose of local anaesthetic use. [1,2,9,12,13,18] The other side effects like pruritits, nausea and shivering were not observed in any of the patients unlike other studies where few side effects were reported with the use of opioid adjuvant. [1,6,7,9,12,17] Thus the study highlighted the adequacy of sensory and motor blockade of more than 2 hrs duration with lower incidence of hypotension and vasopressor use there by proving the efficacy of 7.5 mg bupivacaine with fentanyl for better patient outcomes.…”

“…[1,2,9,12,13,18] The other side effects like pruritits, nausea and shivering were not observed in any of the patients unlike other studies where few side effects were reported with the use of opioid adjuvant. [1,6,7,9,12,17] Thus the study highlighted the adequacy of sensory and motor blockade of more than 2 hrs duration with lower incidence of hypotension and vasopressor use there by proving the efficacy of 7.5 mg bupivacaine with fentanyl for better patient outcomes. Hence the results can be extrapolated to other surgery of this duration in elderly (like inguinal surgery, fractures etc)…”

“…to 4.5 hrs was observed by kuusniemi et al [7] and in a metaanalysis by Sirivanasandha et al [14] when they studied patients receiving 7.5 mg bupivacaine with fentanyl. Kotwani and Dalvi et al [12,10] though reported slightly less time of 2 hrs sensory block in their respective studies but the duration was assessed till the level of sensory block receded to L1 in their study as against S2 level studied in rest of the studies including ours.…”

“…Kotwani M et al checked the onset every 5min hence could have reported longer time of onset of anaesthesia of 9.8 min in patients receiving 7.5mg bupivacaine with 25 µgm fentanyl. [12] The height of anaesthesia required for such surgeries is generally at T10 level. we observed that.…”