Intrathecal sufentanil or fentanyl as adjuvants to low dose bupivacaine in endoscopic urological procedures

Abstract

Context:Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia.Aim:The aim of this study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures.Settings and Design:Prospective, randomized, double-blind study.Materials and Methods:A total of 90 elective endoscopic urological surgery patients, 40-80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 g (Group B) or fentanyl 25 g (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia.Results:The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post-operative analgesic was significantly delayed in Group B patients.Conclusions:Spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

“…The 2 groups showed the same efficacy of spinal block by measuring and comparing the levels of anesthesia, analgesia and motor blockade. Our results are compatible with those from the study done by Gupta et al 17 The Gupta et al 17 study found 13.0% of hypotension in group B. However, there was no hypotension found in Group F. This was different from our study, as hypotension was found in 12.9% of patients in group F. The dose of fentanyl 25 mcg, administered intrathecally, may be too high for Thai people.…”

“…Elderly patients may be more susceptible to sustained hypotension in comparison to younger patients, in so saying, Gupta et al's 17 patients' age were 62.9 years of age on average. Gupta et al 17 found that group B had 3.3% of bradycardia. Group F had 3.3% of pruritus.…”

“…14,15 Kuusniemi et al 16 demonstrated that mixing 25 micrograms (mcg) of fentanyl to 5 mg of bupivacaine provided an effective level of an esthesia and motor block. Gupta et al, 17 revealed that intrathecal administration with 7.5 milligrams (mg) of bupivacaine contributed to 13.3% of hypotension, whereas, a decreased dose of bupivacaine to 5 mg, in combination with fentanyl 25 mcg resulted in no event of hypotension.…”

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus

“…[5][6][7][8][9] Given increasing demand for effective, low-dose neuraxial techniques, selection of intrathecal opioid has been the topic of several recent studies. [10][11][12][13] Fentanyl and sufentanil are lipophilic opioids with similar chemical structure and intrathecal pharmacokinetics. 14 They exhibit structural similarities to local anesthetics and exert an effect on sensory C afferent nerve fibers.…”

Combined low dose local anesthetics and opioids versus single use of LA for transurethral urological surgery: A meta-analysis

“…Through searching in databases and screening with preset criteria, a total of twelve studies [6][7][8][11][12][13][14][15][16][17][18][19] were included for following a meta-analysis. The search process was described in Figure 1.…”