Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries

Abstract

Background and Aims:This study aims to compare the anesthesia characteristics between buprenorphine and fentanyl when added as an adjuvant to intrathecal ropivaciane in an attempt to prolong the duration of spinal anesthesia.Material and Methods:The present prospective double-blind study was undertaken on ninety American Society of Anesthesiologist I and II patients between 18 and 60 years of age undergoing subarachnoid block for lower limb surgery. Group I (n = 30) patients were administered 3 ml of intrathecal solution (2.8 ml of 0.75% ropivacaine + 0.2 ml of isotonic sodium chloride), while Groups II and III patients (n = 30 each) received 2.8 ml 0.75% ropivacaine + 0.2 ml buprenorphine (60 μg) and 2.8 ml 0.75% ropivacaine + 0.2 ml fentanyl (10 μg), respectively. Following parameters were observed: Onset times and duration of sensory and motor block, time to first analgesic use, total dose of rescue analgesia, intra- and post-operative pain scores based on visual analog scale, sedation scores, hemodynamic parameters, and side effects if any. Data were analyzed by appropriate statistical tests and P < 0.05 were considered significant.Results:Time to onset of sensory and motor block in all the three groups was comparable. However, duration of sensory block was significantly prolonged in Groups II and III in comparison to Group I (P < 0.05) and it was the longest in Group II (P < 0.05). The duration of motor blockade was similar in all the three groups. The time to first analgesic dose was also significantly prolonged in Groups II and III as compared to Group I (P < 0.05) but was comparable between Groups II and III. Intra- and post-operative hemodynamic parameters, as well as side effects, were comparable.Conclusion:Addition of buprenorphine and fentanyl as adjuvants to intrathecal 0.75% ropivacaine prolongs postoperative pain relief without causing any increase in the duration of motor blockade but buprenorphine is better as compared to fentanyl in prolonging the duration of sensory block and achieving a better outcome in terms of pain relief.

Intrathecal hyperbaric bupivacaine with varying doses of buprenorphine for postoperative analgesia after cesarean section: A comparative study

“…also found a significantly lower requirement of rescue analgesic with addition of 60 μg buprenorphine to intrathecal ropivacaine. [ 8 ]…”

“…[ 5 ] Its high lipid solubility, high affinity for opioid receptors, and long duration of action makes buprenorphine a good choice as an adjuvant to intrathecal LA for managing moderate to severe postoperative pain. [ 8 9 ] Buprenorphine is readily available as a preservative-free preparation which is compatible with the cerebrospinal fluid (CSF). Intrathecal doses (30 μg–150 μg) are much smaller than parenteral doses and are known to prolong analgesia without sensory or motor blockade.…”

“…[ 3 8 9 ] Being more lipophilic than morphine, buprenorphine has low medullary bioavailability after neuraxial administration so that the occurrence of side effects is lesser, making it an attractive alternative. [ 5 8 ] Several studies have demonstrated efficacy of buprenorphine as an adjuvant to LA in SAB; however, optimal dose which provides a balance between analgesia and adverse effects has not been described and also there are very limited studies in patients for cesarean section. The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section.…”

A prospective randomized study on the impact of low-dose dexamethasone on perioperative blood glucose concentrations in diabetics and nondiabetics

“…Spinal anesthesia has been proved to be more effective than general anesthesia in suppressing stress and glycemic response in elective surgical patients. [ 20 ] The addition of buprenorphine has been found to prolong the duration of spinal analgesia to 7.44 ± 1.69 h.[ 7 ] The control groups in our study had a blunted hyperglycemic response during the study, but the groups that received dexamethasone had a significant hyperglycemic response.…”

“…Buprenorphine offers the advantage of providing good analgesia while allowing early ambulation of the patient by sparing sympathetic and motor nerves. [ 2 3 4 5 6 7 ] The use of buprenorphine has been associated with postoperative nausea and vomiting the incidence of which has been found to be as high as 34%. [ 3 5 ] Dexamethasone is a potent corticosteroid with anti-inflammatory and immunomodulating effects.…”