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Comparison of Premixed Versus Sequential Administration of Fentanyl as an Adjuvant to Intrathecal Hyperbaric Bupivacaine in Infra-Umbilical Surgeries: A Randomized Controlled Study

Soma Ganesh Raja, Assistant Professor, Department of Anaesthesia, Sri Ramachandra Medical College & Research Institute, Porur, Chennai, Tamil Nadu 600116, India. , Soma Ganesh Raja1 , Gowri Shankar Sarate2

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Indian Journal of Anesthesia and Analgesia 5(5):p 843-848, May 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5518.24

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Abstract

 

Opioids and local anaesthetics administered together intra-thecally have potent synergistic analgesia. 

Aims and Objectives: To compare the efficacy of premixed versus sequential administration of fentanyl as an adjuvant to intrathecal hyperbaric bupivacaine following spinal anaesthesia in infra-umbilical surgeries. 

Methodology: This study was carried out in a tertiary care center where 140 orthopaedic, urology and general surgery patients scheduled for elective infra umbilical surgery under spinal anaesthesia were enrolled. All the patients were randomly divided into two groups with 70 patients in each group. Patients in group A received intrathecal hyperbaric bupivacaine 12.5 mg premixed with fentanyl 25 mcg. The drugs were mixed together in a single syringe just before intrathecal injection. Those in group B received fentanyl 25mcg followed by sequential administration of hyperbaric bupivacaine 12.5mg in a separate syringe intrathecally. The vitals were monitored and recorded, progression of spinal block was assessed and all data collected were analysed using appropriate statistical methods. 

Results: More patients in group A achieved a higher level of intrathecal block than in group B. However, time to regress L1 spinal level was significantly less in group B compared with group A (p-value 0.001). Also, patients in group B achieved maximum sensory level earlier than group A. Time to regression of motor block to Modified Bromage I was also significantly more in group B than in group A. Haemodynamically, there was no significant difference in the baseline heart rate and blood pressure between both the groups. After spinal anesthesia, heart rate and blood pressure (both systolic and diastolic) decreased in both groups minimally without statistical significance. Postoperatively, in both the groups very few patients required rescue analgesics. The incidence of adverse effects was comparable in both the groups without statistical significance. 

Conclusions: Fentanyl given sequentially in a separate syringe as adjuvant to intrathecal hyperbaric bupivacaine can result in faster onset of both sensory and motor block and prolongs the duration of spinal anaesthesia. Also, it minimises clinically significant side effects and reduces the postoperative analgesic requirements.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5518.24

Keywords

Opioids; Intrathecal; Spinal Blockade. 

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