Haemodynamic Comparison between Isobaric Bupivacaine Fentanyl and Isobaric Ropivacaine Fentanyl for Lower Abdomoinaland Lower Limb Surgery

Abstract

Background: Spinal anesthesia is the most commonly used method of anaesthesia and analgesia in lower limb surgeries. Spinal anaesthesia causes more sympatholysis and haemodynamic disturbances than general anesthesia. A low dose of local anaesthetic is preferred which may occasionally cause failure of spinal anaesthesia. Therefore, different adjuvants are added to local anesthetic to achieve desired level anesthesia. Aim: The aim of this study was to compare intraoperative haemodynamic changes associated with intra thecal use of isobaric 0.5% Bupivacaine 3ml(15mg)and isobaric 0.5% Ropivacaine 3ml(15mg)both with 20 mcg(0.4ml) Fentanyl in patient undergoing lower abdominal and lower limb surgery. Subjects and Methods: 100 patients were divided into two groups of fifty each. First group (Group B) was given spinal anaesthesia with 0.5% bupivacaine 3ml(15mg) with 20mcg (0.4ml) Fentanyl and second group (Group R) was given spinal anaesthesia 0.5% ropivacaine 3ml(15mg) with 20mcg (0.4ml) Fentanyl. Baseline and intra operative haemodynamic parameters; onset and duration of sensory and motor blockade were evaluated. Unpaired Students t-test and analysis of variance were applied for quantitative data and Chisquare test for qualitative data. Results: Incidence of hypotension was greater in Bupivacaine group than Ropivacaine group (p=0.001). Duration of sensory and motor blockade was less in Ropivacaine group than Bupivacaine group (p<.05). Conclusion: Ropivacaine Fentanyl provided better haemodynamic stability and shorter duration of motor block as compared to Bupivacaine Fentanyl so it is a better choice of anaesthesia in surgeries and early ambulation.

A Comparison of the Intrathecal Isobaric 0.5% Levobupivacaine with Fentanyl and Isobaric 0.5% Ropivacaine with Fentanyl for Lower Abdominal and Lower Limb Surgeries: A Prospective Randomised Double Blind Controlled Study

“…In the present study, the mean duration of sensory blockade was longer in Group I (241.57 ± 1.87 min) when compared with Group II (196.28 ± 1.57 min) and was statistically significant (P value < 0.001). Our results are in accordance with the study conducted by Varun S et al [6] Jagtap et al [15] compared 15 mg of 0.5% ropivacaine with 25 µg fentanyl and 15 mg of 0.5% bupivacaine with 25 µg fentanyl, and found out that the time to sensory regression to L1 dermatome was faster in the ropivacaine group compared with the bupivacaine group (P -0.36) which is similar to our results. Mantouvalou et al [16] in their study found out that the duration of sensory block was 230 minutes, 240 minutes and 200 minutes respectively, while comparing 15 mg of isobaric levobupivacaine with 15 mg of isobaric bupivacaine and 15 mg isobaric ropivacaine.…”

“…Our study shows a slight contrast with Breebaart et al [14] which can be explained due to the different dose of levobupivacaine used and also because no adjuvant was used in their study. In our study, highest sensory dermatome level reached was T6 level in both the groups, number of patients reaching the T6 sensory dermatome level block was comparable in both the groups which is similar to the study done by Srilakhshmi et al [2] and Varun et al [6] In our study, the onset of motor blockade was faster in Group I (3.53 ± 0.17min) than in Group II (4.48 ± 0.10 min).Our results are comparable to studies conducted by Indumathi et al, [12] Mehta et al [18] and Srilakshmi et al [2] Total duration of motor blockade was longer in Group I (187.48 ± 12.12 min) than in Group II (160.75 ± 1.89 min).Our study is in accordance with the study of Kolkta et al [19] in which they compared the equipotent doses of isobaric ropivacaine and isobaric bupivacaine (19.5 mg and 13 mg respectively) with fentanyl 20 μg,, however the individual readings of motor block of ropivacaine group shows slight difference which may be due to the different dose of ropivacaine used. Our results are coinciding with the study conducted by Layek et al [20] in which the duration of motor block was significantly longer in group Bupivacaine when compared to group Ropivacaine in elective infraumbilical orthopedic surgery.(P<0.001).…”

“…In our study, the mean onset of sensory blockade was faster in Group I (2.62 ± 0.95 min) when compared with Group II (3.39 ± 0.13 min). This observation is comparable to the study conducted by Varun et al [6] in which they compared 3 ml 0.5% isobaric bupivacaine plus 20 µg fentanyl and 3 ml 0.5% isobaric ropivacaine plus 20 µg fentanyl and found that time taken to achieve T10 level of Section: Anaesthesia sensory block was significantly more in ropivacaine fentanyl group as compared to bupivacaine fentanyl group. (P<0.05) Indumathi et al [12] carried a study to compare the block characteristics and haemodynamic stability of intrathecal isobaric Ropivacaine and Levobupivacaine with Fentanyl and Magnesium as adjuvants for lower abdominal surgeries and observed that time to reach T10 dermatome was faster in levobupivacaine group compared to ropivacaine group which was statistically significant (P<0.001), which is similar to our study.…”

“…It prolongs the duration and reduces analgesic requirement in early postoperative period following spinal anaesthesia. [6] Till now, various studies have been done comparing the efficacy and safety of isobaric ropivacaine with fentanyl verus isobaric bupivacaine with fentanyl in spinal anaesthesia, but very few studies are available comparing the block characteristics of isobaric ropivacaine with fentanyl and isobaric levobupivacaine with fentanyl. So, we conducted a randomized double blinded study on 80 patients undergoing lower abdominal and lower limb surgeries under spinal anaesthesia to compare the efficacy of isobaric levobupivacaine with fentanyl and isobaric ropivacaine with fentanyl.…”

“…[4,5] In recent years, use of intrathecal adjuvants like opioid analogues have gained popularity with the aim of prolonging the duration of block, improving success rate, patient satisfaction and reducing resource utilization compared with general anaesthesia and faster recovery. [6] Fentanyl (a lipophilic opioid) has a rapid onset and short duration of action following intrathecal administration. [7] It prolongs the duration and reduces analgesic requirement in early postoperative period following spinal block.…”