Effects of isobaric ropivacaine with or without fentanyl in subarachnoid blockade: A prospective double-blind, randomized study

Abstract

Background:The addition of fentanyl to ropivacaine has shown to improve the quality of analgesia without compromising its benefits such as early mobilization and early voiding.Aim:The aim of the study was to evaluate the effects of the isobaric ropivacaine in combination with fentanyl and compare it with the isobaric ropivacaine alone in spinal anesthesia for lower abdominal and lower limb surgeries.Settings and Design:Double-blinded randomized controlled trial.Subjects and Methods:Hundred patients belonging to American Society of Anesthesiologists physical status I and II scheduled for either lower abdominal or lower limb surgery under spinal anesthesia were included. The study was a prospective double-blinded randomized controlled trial where patients were randomly allocated into two groups to receive either 2.5 ml of 0.75% (18.75 mg) isobaric ropivacaine with 25 μg fentanyl (Group RF) or 2.5 ml of 0.75% (18.75 mg) isobaric ropivacaine with 0.5 ml of 0.9% saline (Group R) intrathecally.Statistical Analysis:Data analysis was done by Student's unpaired t-test. SPSS version 16 was used. P < 0.05 was considered as statistically significant.Results:We found no significant difference in hemodynamics, onset of sensory and motor block, peak level of block, recovery from motor block, return of micturition and incidence of side effects with the addition of fentanyl to ropivacaine. First request for analgesia was required earlier in the control group. There was also a significant prolongation of the duration of sensory block (mean - 341.6 min) and postoperative analgesia in Group RF (mean - 442.2 min) (P < 0.001).Conclusion:The addition of fentanyl to ropivacaine significantly prolongs the duration of postoperative analgesia with clinically insignificant influence on hemodynamics and motor blockade with minimal side effects.

Effect of Continuous Spinal Anesthesia and Single Shot Spinal Anesthesia on Hemodynamics for Lower Abdominal and Hip Surgeries in Adults: An Observational Study

“…In present study, HR was comparable within the group and between the groups till the completion of surgery. Studies of Saber R et al, [14], Klimscha W et al, [7], Favarel-Garrigues JF et al, [8], Lundorff L et al, [15], Maurer K et al, [11], Fettes PDW et al, [16], Baydilek Y et al, [17], Seetharam KR et al, [18] also showed similar results. Ebied RS et al, [19] found significant fall in HR relative to baseline (p<0.05) in CSA but were within the clinically acceptable range which might be due to the addition of fentanyl with 0.5% isobaric bupivacaine into the subarachnoid space in their study.…”

Effects of fentanyl on isobaric ropivacaine in subarachnoid anaesthesia for lower abdominal and lower extremity surgeries

“…These results were in accordance with the Kaushik rao et al, Boztug et al and Sanli et al proved that fentanyl do not alter the motor effects of ropivacaine spinal anaesthesia. [11][12][13] Postoperative analgesia requirements in this study prolonged significantly in fentanyl group. The total analgesic requirements also decreased.…”

“…9 In the present study, sensory level of T4 was observed in group RF but in group RC the extent of sensory block reached only up to T7 dermatome. Koltka et al reported that 19.5 mg ropivacaine with 20 μg of fentanyl for spinal anaesthesia in lower abdominal surgeries, peak level of sensory block achieved was T7 (T4-T9), Kaushik rao et al 10,11 with 19.5 mg ropivacaine with 20 μg of fentanyl was T6 (T4-T9). These results were in accordance with our results.…”

“…Similarly, Kaushik rao et al, Boztug et al Sanli et al and Layek et al found that time for analgesic requirement prolonged in fentanyl group compared to control group. [11][12][13]17,18 Intraoperative hypotension seen in 5 patients (3 in R vs2in RF), postoperative shivering in 4 patients (2 in each group), pruritus in one patient of RF group. Koltka et al reported 20% of patients who received ropivacaine with fentanyl had hypotension and 3% had bradycardia.…”

“…Kaushik rao et al reported S2 regression time (Group R vs. Group RF, 240.4±13.087 min vs. 341.6±15.032 min) and Sanli et al 13 reported time to regression to L5 (Group S vs. Group F, 150.3±13.4 min vs. 168.3±17.3 min) were prolonged significantly in fentanyl group. 11 Fentanyl is highly lipid soluble and rapidly binds to opioid receptors present in the dorsal horn of spinal cord helps on faster onset of sensory block. Fluctuating pressure changes occur in cerebrospinal fluid due to respiration and cardiac cycle.…”