Comparison of Intrathecal Fentanyl and Buprenorphine as an Adjuvant to 0.5% Hyperbaric Bupivacaine for Spinal Anesthesia

Abstract

Purpose: This study was designed to evaluate and compare three groups, that is, (1) normal saline 0.5 mL with 15 mg of 0.5% hyperbaric bupivacaine normal (BN), (2) intrathecal fentanyl 25 μg (0.5 mL) as an adjuvant to 15 mg of 0.5% hyperbaric bupivacaine fentanyl (BF), and (3), 150 μg buprenorphine with 15 mg of 0.5% hyperbaric bupivacaine buprenorphine (BB) with respect to the onset and duration of sensory and motor spinal block, level of anesthesia, effects on hemodynamic parameters, requirement of postoperative analgesia, and side effects in patients aged 16–60 years undergoing surgical and orthopedic procedures requiring spinal anesthesia. Methods: A prospective, observational study was performed at a single center with 90 consecutive patients enrolled as per the inclusion criteria. Patients were divided into three groups of 30 each based on drugs administered, BN, BF, and BB groups, and outcome measures were recorded. The three groups were compared with the analysis of variance test for the continuous variables, with P < 0.05 considered statistically significant. Results: The groups were similarly matched with respect to age. The earliest onset of sensory block was in the BF group (2.87 min), P < 0.05. Similarly, the mean time to achieve the highest sensory level was least in the BF group (9.63 min), P < 0.05. The onset of motor blockade was earliest in the BB group (7.65 min), P < 0.05. The mean time for two segment regression was maximum in the BB group (126.03 min), P < 0.05. The mean time for regression to L1 was the longest in the BB group (200.83 min), P < 0.05. Maximum duration of analgesia after spinal drug administration was the highest in the BB group (412.17 min), P < 0.05. Conclusion: The addition of both buprenorphine 150 μg and fentanyl 25 μg to 0.5% hyperbaric bupivacaine 15 mg enhances the quality and duration of sensory block for spinal anesthesia providing better postoperative analgesia, while decreasing the incidence of complications associated with each drug alone.

Eficacia anestésica de la buprenorfina en la anestesia multimodal intratecal en histerectomías abdominales: ensayo clínico

“…En los tres grupos, la hipotensión se presentó en más del 50%, observándose que en el grupo BM fue, en la mayoría de los casos, antes de la entrada de compresas a cavidad, y en los grupos BBMD y FBMD posterior a ésta. (3,4) , y que el manejo anestésico con buprenorfina como coadyuvante a otros anestésicos espinales prolongan la duración de la misma con menos bloqueo motor y mayor analgesia postoperatoria (9)(10)(11)(12) . Por su alta liposolubilidad, la buprenorfina tiene mayor afinidad por la sustancia blanca, la grasa peridural y la mielina, y de ahí es aclarada al plasma con rapidez, llegando a los receptores opiáceos sólo un 8% (5) .…”

“…La falta de conocimiento sobre su seguridad, farmacocinética y farmacodinamia, así como, una interpretación incorrecta de los términos «actividad intrínseca», «eficacia» y agonista «total o parcial» ha hecho que muchos médicos pasen por alto su uso; además, la buprenorfina presenta un efecto techo para la depresión respiratoria, pero no para la analgesia (8) . Su alta liposolubilidad, gran afinidad por los receptores mu y su acción prolongada han hecho de la buprenorfina un adyuvante excelente para los anestésicos locales en la anestesia espinal, ya que prolonga la duración de la misma, con menos bloqueo motor y mayor analgesia postoperatoria (9)(10)(11)(12) . El objetivo de este estudio fue sustituir al fentanilo por buprenorfina en la AMI para evaluar si, al combinarla con los demás medicamentos, tiene eficacia anestésica en las HTA.…”

Comparative study on analgesia duration with bupivacaine-buprenorphine combination vs. bupivacaine alone for cesarean delivery

“…Shrinivas et al 13 also observed a lower incidence of nausea and vomiting with buprenorphine, which aligns with our results. Dhawale et al 17 investigated the use of intrathecal fentanyl instead of buprenorphine and reported similar outcomes in terms of analgesic duration. However, no studies directly comparing bupivacaine-buprenorphine combination with bupivacaine alone for cesarean delivery were found.…”