Comparison of intrathecal bupivacaine with or without fentanyl for urosurgeries (original) (raw)
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EAS journal of anaesthesiology and critical care, 2022
Introduction: Spinal anesthesia is the most commonly used technique for lower abdominal surgeries postoperative pain control is a major problem because spinal anesthesia using only local anesthetics is associated with relatively short duration of action, and thus early analgesic intervention is needed in the postoperative period. Short acting spinal anaesthesia may help to prevent complications associated with delayed immobilization. Objective: To examine whether adding intrathecal Fentanyl to bupivacaine intensify sensory and motor block without prolonging recovery time for urosurgeries. Materials and Methods: A prospective observational study was contact at dept. of Anaesthesia, Shaheed Tajuddin Ahmad Medical College Hospital, Gazipur, Bangladesh from March to August 2021. Seventy five (75) patients included in our study. American Society of Anaesthesiologists physical status I and II scheduled for elective urological procedures were studied in a double-blinded, randomized prospective manner. Random allocation was done as, Group A (n=25) receiving intrathecal bupivacaine 12.5 mg; Group B (n=25) bupivacaine 10 mg with 25 μg of fentanyl; and Group C (n=25), bupivacaine 5 mg with 25 μg of fentanyl. Assessment of sensory, motor block and duration of sensory analgesia was done. Results: In our study the demographic data were comparable in all the three groups. The time for two segment regression was statistically significant between all three groups (p<0.001). The mean time for two segment regressions for group A was 104.8 minutes whereas for group B mean time was 161.8 min and for group C mean time was 80.37 minutes. It was longest for group B and shortest for group C. The total duration of motor block was compared among the three groups after initiation of the SAB. There was statistically significant difference regarding total duration of motor block, time for two segment regression and duration of sensory analgesia between each pair of groups. The duration of motor block, time for two segment regression and duration of sensory analgesia was found to be longest in Group B and shortest in Group C. There were no significant differences in the incidence of complications. Conclusion: Addition of 25 μg fentanyl to 5 mg bupivacaine resulted in short-acting motor block whereas with 10 mg of bupivacaine, it increased the intensity and duration of motor block, prolonged sensory analgesia and two segment regression times.
Anesthesiology and Pain Medicine, 2014
Background: The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia and prolong the duration of analgesia, when using a subarachnoid block in Iranian patients with their specific pain tolerance. Objectives: The aim of this study was to evaluate the effects of adding fentanyl or sufentanil, to intrathecal bupivacaine, in terms of the onset and duration of; sensory block, motor block, hemodynamic effects and postoperative pain relief. Patients and Methods: This randomized clinical trial included 90 patients who underwent orthopedic lower limb surgeries. Subjects were divided into experimental groups; intrathecal fentanyl 25 µg (F), and sufentanil 2.5 µg (S), along with a placebo 0.5 mL normal saline (C) group, which were added to bupivacaine 0.5%, 15 mg. Duration of complete and effective analgesia was recorded (by a visual analogue scale-VAS). The pain scores were assessed postoperatively. Intraoperative mean arterial pressure (MAP), heart rate and oxygen saturation (SPO 2 ) were recorded. The incidence of side effects such as; nausea, vomiting, pruritus, shivering, bradycardia and hypotension were also recorded. Results: MAP and heart rate results showed no significant changes at the designated time points among the three groups (P > 0.05). However, SPO 2 and VAS showed significant changes at the designated time points among the three groups (P < 0.05). The duration of complete and effective analgesia was also significantly longer in the sufentanil group (P < 0.05). Motor block did not exhibit any significant difference (P = 0.67). Only pruritus as a side effect was significantly higher in the sufentanil group (P < 0.05), while all other evaluated side effects were significantly lower in the sufentanil group (P < 0.05).
Indian Journal of Clinical Anaesthesia, 2021
Spinal anaesthesia is preferred for lower abdominal and lower limb surgeries. Bupivacaine is the most popular local anaesthetic for subarachnoid blockade because of less neurotoxicity. Intrathecal bupivacaine alone may be insufficient to provide prolonged post-operative analgesia, even with high sensory block. So, various adjuvants are used like ketamine, midazolam, clonidine, opioids, neostigmine etc. to prolong the effect of local anaesthetic.To compare the effect of intrathecal fentanyl and fentanyl-midazolam combination with hyperbaric bupivacaine for quality of anaesthesia and post-operative analgesia.Study was conducted on 60 patients aged 20-60 years and were randomly divided into two groups of 30 patients each. Group A received 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl 0.5 ml (25µg) and Group B 0.5% bupivacaine heavy 2.8 ml (14mg) +fentanyl 0.5 ml (25 µg) + midazolam 0.2 ml (1mg). Total volume is 3.5 ml in both groups. They were assessed for quality of block, post-operat...
Srpski Arhiv Za Celokupno Lekarstvo, 2021
Introduction/Objective Spinal anesthesia is often used for hip endoprosthesis surgery. Significant surgical stress response consisting of hormonal, metabolic and inflammatory changes can be initiated by the hip replacement surgery. Intrathecal opioids, as adjuvants to local anesthetics, make spinal block sufficient even with lower doses of the local anesthetics, and the incidence of the side effects reduce to minimum. Methods This study included 162 patients of either sex, American Society of Anesthesiology classification (ASA) 1-2, scheduled for total hip arthroplasty. The patients had spinal anesthesia with 10 mg of 0.5% bupivacaine with 20 µg (Group I), or 25 µg (Group II) or 30 µg fentanyl intrathecally (Group III). Results Mean time to achieve maximum motor and sensory blockade was with no significant difference among the groups. Time of motor block duration was shorter in the Group III. Four hours after the operation, patients in the Group I had significantly higher cortisol serum levels. Blood glucose levels were with no significant difference among the groups. Levels of CRP increased remarkably postoperatively in the Group I. Incidence of hypotension, bradycardia, nausea and vomiting was significantly higher in the Group III. Pruritus and shevering were not recorded among the groups. The first time an analgetic was needed postoperatively was the longest in the Group III. Conclusion The dose of 10 mg of bupivacaine combined with 25 µg fentanyl was the optimal option to achieve hemodynamic stability, sufficient sensory and motor blockade, and reduce the stress response and incidence of the opioids side effects such as vomiting, nausea, pruritus etc.
2018
Opioids have an important place as adjuvant to local anaesthetic agents in the management of spinal anaesthesia, the most commonly used being fentanyl. Other alternatives like opioid agonist antagonist agents like nalbuphine, butorphanol and buprenorphine are now being studied as adjuvants to prolong the duration of sensory and motor block with lower incidence of opioid related side effects. 60 patients belonging to ASA status I and II of either sex were randomly divided into three groups of 30 each to receive either butorphanol25 µg (Group A) or fentanyl 25 mcg (Group B)) with 2.5 mL 0.5% hyperbaric bupivacaine, making intrathecal drug volume to 3mL in each group.. Sensory and motor block characteristics in terms of time to onset and duration were recorded for each group. Drug-related side effects of pruritus, nausea/vomiting, and respiratory depression were also recorded. The two groups were comparable regarding the demographic profile. The fentanyl group showed delayed onset of sensory block (274 ± 73.39 sec) as well as a longer duration of sensory block (145.07 ± 5.34 mins vs 141.33 ± 3.51) than butorphanol. The duration of motor block was also prolonged in the fentanyl group(149 ± 7.13 vs 140.37 ± 2.31). Both the findings were significant. Butorphanol provided a significantly longer duration of postoperative analgesia (250.10 ± 4.05 vs 244 ± 7.11 min). No drug related side effects were observed in either group. Addition of 25 μg of butorphanol as adjuvant to hyperbaric bupivacaine 0.5% provides a faster onset of sensory block as compared to 25 μg fentanyl. Fentanyl provided a significantly greater duration of both sensory and motor block than butorphanol. The duration of postoperative analgesia was significantly greater with butorphanol.
Regional Anesthesia and Pain Medicine, 2001
Background and Objectives: To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 g/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 g/mL for axillary brachial plexus block. Methods: Sixty patients were randomly allocated to 3 groups and received axillary brachial plexus block with 40 mL bupivacaine 0.25% (group B), 40 mL bupivacaine 0.25% with fentanyl 2.5 g/mL (group BF), or 40 mL bupivacaine 0.125% with fentanyl 2.5 g/mL (group DBF). The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events were noted. Results: The mean duration of sensory block and analgesia were longer in group BF (10.1 hours and 20.9 hours) than group B (6.9 hours and 11.6 hours) and DBF (5.9 hours and 12.0 hours) (P Ͻ .01, P Ͻ .001, respectively). The mean duration of motor block was also longer in group BF (10.7 hours) than group B (4.9 hours) (P Ͻ .01). Only 2 patients experienced motor block in group DBF. The frequency of successful block was 35% in group DBF (P Ͻ .01). Hemodynamic parameters were similar in all groups. In group B, only 1 patient experienced dizziness. Nausea was observed in 1 patient in each fentanyl group. Conclusion: The addition of 100 g/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone.
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Spinal anaesthesia with hyperbaric Bupivacaine Hydrochloride has been popular for surgical procedures. The need to intensify and increase duration of sensory blockade without affecting motor blockade has led to the addition of fentanyl, thus prolonging the duration of post-operative analgesia. Aim of this study is to assess the duration and quality of post-operative pain relief when Hyperbaric Bupivacaine Hydrochloride is combined with fentanyl for sub-arachnoid block and also to study the prolongation of motor and sensory blockade. MATERIALS AND METHODS 75 patients were randomly allocated into the following three groups Group A received SAB with 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric) Group B received SAB with addition of 10g fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric). Group C received SAB with addition of 25g fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric). RESULTS Mean duration of analgesia was increased with addition of fentanyl with 0.5% hyperbaric Bupivacaine intrathecally. Mean duration of analgesia was statistically highly significant in the fentanyl groups. The total dose of analgesics given in the postoperative period was highest in group A which was statistically significant. Times for two segment regression of sensory level were prolonged in group B and group C thus increasing the duration of sensory analgesia. Time to full motor recovery was not delayed in any of the three groups. The haemodynamic changes were similar in all the three groups with minimal changes in pulse rate and systolic blood pressure. CONCLUSION The addition of intrathecal fentanyl to the local anaesthetic injected intrathecally in subarachnoid block prolonged sensory analgesia obtained by the block without hampering recovery from motor block or causing untoward haemodynamic disturbances. Dose of 10 g fentanyl provided all these benefits which were accentuated by increasing the dose to 25g. Hence a dose of 10 g to 25 g as deemed fit is useful for this purpose.
Anaesthesia and Intensive Care, 2009
The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 μg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 μg (group R, n=26) or plain bupivacaine 13 mg with fentanyl 20 μg (group B, n=26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher. The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P <0.05). There was no difference in the onset time of motor block. The duration of motor block (Bromage score >0) was shorter in group R (139±39 minutes vs group B 182±46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90±25 minutes vs 130±40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 μg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 μg for spinal anaesthesia in lower abdominal surgery.
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND In spinal anaesthesia, commonly used drugs are isobaric bupivacaine and hyperbaric bupivacaine. Commonly opioids like fentanyl are used as adjuvants with local anaesthetics to improve analgesic intensity and to achieve faster onset and prolonged duration. This study aims at comparing isobaric bupivacaine-fentanyl and hyperbaric bupivacaine-fentanyl primarily, in terms of onset and duration of sensory and motor blockade and secondarily, in terms of haemodynamic changes and associated complications. MATERIALS AND METHODS Eighty patients belonging to American Society of Anaesthesiologists I and II undergoing infraumbilical surgeries under spinal anaesthesia were randomised into two groups. Group A received 3 ml of 0.5% isobaric bupivacaine with 25 micrograms fentanyl, while Group B received 3 ml of 0.5% hyperbaric bupivacaine with 25 micrograms fentanyl. Student's unpaired t-test and the χ2 test were used to analyse the results, using the SPSS version 11.5 software. RESULTS The mean onset of sensory block was significantly faster in Group B (3.55 ± 0.96 min) than in Group A (5.70 ± 0.69 min). The mean duration of sensory block was significantly longer in Group B (189.65 ± 9.58 min) than in Group A (129.08 ± 3.47 min). The mean onset of motor block was significantly faster in Group B (4.78 ± 0.80 min) than in Group A (7.83 ± 0.78 min). The mean duration of motor block was significantly longer in Group B (204.55 ± 12.46 min) than in Group A (171.18 ± 4.31 min). Isobaric bupivacaine-fentanyl mixture was associated with better haemodynamic stability as compared with hyperbaric bupivacaine-fentanyl mixture. CONCLUSION Intrathecal isobaric bupivacaine-fentanyl mixture is associated with lesser duration of both sensory and motor blockade, thereby enabling quicker recovery from anaesthesia and also better haemodynamic stability as compared with hyperbaric bupivacaine fentanyl mixture for infraumbilical surgeries.
Introduction: Intrathecal anesthesia and epidural anesthesia (EA) are the most popular regional anesthesia techniques used for surgeries below umbilicus. EA is more versatile in providing anesthesia, analgesia and treatment of chronic disease syndromes. It provides better postoperative pain control and more rapid recovery from surgery. It also provides effective prolonged surgical anesthesia, prolonged postoperative analgesia, reduces the incidence of hemodynamic changes and reduces the incidence of PDPH as the dura is not pierced. Aims And Objectives: To Compare with the efficacy of lumbar epidural block with 0.5% bupivacaine 10ml with Fentanyl 50µg and 0.5%bupivacaine 10ml with butorphanol 1mg in lower limb surgeries focusing on Onset and duration of analgesia, Cardio respiratory effects, Sedation, Adverse effects Summary: The study was conducted to compare the effect in lower limb surgeries. 100 patients belonging to ASA grade I&II were selected. Bupivacaine (0.5%) 10ml with fentanyl (50µg) was given in Group I, and Bupivacaine (0.5%)10ml with butorphanol (1mg) was given in Group II. The patients studied across the group did not vary much with respect to age, sex or height. The onset of sensory blockade was delayed by about 20 seconds in groupII and the onset of motor blockade was delayed by about 20-25 seconds in group-II compared to group-I. Duration of sensory blockade in Group II is longer compared to group I , thus prolonging the duration of analgesia. Duration of motor blockade in group II is prolonged than in Group I. The time of first request of analgesics by the patients in group-II is longer (360 minutes) compared to group-l (206 minutes) thus prolonging the duration of analgesia. Visual analogue scores were significantly lower in group-II compared to group-l thus reducing the requirement of supplemental postoperative analgesics. The adverse effects observed in the study were minimal. Conclusion: Addition of the opioids, i.e., Butorphanol and Fentanyl significantly quickens the onset and prolongs analgesia Onset is fast with Bupivacaine with Fentanyl combination compared with Bupivacaine with Butorphanol combination. Bupivacaine with Butorphanol provide more effective and longer duration of analgesia as compared with Bupivacaine with Fentanyl.