A COMPARATIVE STUDY OF LOW DOSE HYPERBARIC BUPIVACINE WITH

FENTANYL AND HYPERBARIC BUPIVACAINE IN SPINAL ANAESTHESIA FOR

BELOW UMBILICAL SURGERIES.

DR TAHIR S HATTURKAR , DR NIRMALA.B.C

DEPARTMENT OF ANAESTHESIOLOGY ABSTRACT ID : ISAP232
MVJ MEDICAL COLLEGE PRESENTING DATE : 27 NOV 2019
HOSKOTE , BENGALURU CUBICLE 1

INTRODUCTION There was significant difference in mean Duration of Analgesia between

two groups(Group A=178.50 ± 17.96 min,Group B= 254.17 ± 24.53 min)
Local anasthetic like bupivacaine is commonly used in spinal anaesthesia.  
Studies have shown that duration of analgesia due to bupivacaine in Mean Comparison of Duration of Analgesia in Mins
spinal anaesthesia can be prolonged by using adjuvants. Most commonly
300
used opioid in regional anaesthesia is fentanyl. It is highly potent drug 254.17
because of its high lipophilicity. The aim of the present study was to 250

Mean
compare the effect of intrathecal fentanyl as adjuvant to low dose 200 178.5
bupivacaine in the subarachnoid block with regular dose of bupivacaine. 150

100
METHODOLOGY
50
A randomized prospective clinical study involving 60 patients belonging to
0
ASA physical status I to III and height from 150-165cm. Routine pre- Group A Group B
anaesthetic checkup was done. Valid informed written consent was Group
obtained. Patients below 35 and above 90kgs were excluded. Patients were
randomly divided into two groups of 30 each. Group A received 1.5ml of
0.5% hyperbaric bupivacaine with 50mcg fentanyl. Group B received 3ml of DISCUSSION
0.5% hyperbaric bupivacaine, under aseptic precautions, Subarachnoid Bupivacaine is the widely used anaesthetic agent for spinal anaesthesia. It
block was given in lateral position at L2-L3 using a 25 G Quincke’s needle has the advantage of producing good surgical anaesthesia and longer half-
through midline approach and table in neutral position. Patients were life compared to other local anaesthetics, the incidence of adverse effects
turned supine immediately. The following parameters were noted: Onset on haemodynamic stability like hypotension ismorecommon. Perioperative
of sensory block, Onset of motor block, Level of the sensory block, hypotension will affect postoperative recovery and increases risk of
Duration of motor block, Duration of two segment sensory regression, coronary ischaemia. Intra thecal opioids are synergistic with local
Duration of analgesia, Parameters like HR, BP, SPO2 were recorded every 2 anaesthetics and intensify the sensory block. The addition of fentanyl to
mins for the first 10 minutes and every 10 minutes till the end of surgery, hyperbaric bupivacaine increases the intra-operative quality of block and
Any other adverse drug reactions like nausea, vomiting, urinary retention, synergistic antinociceptive effects with local anaesthetics will increase the
pruritis etc were noted. duration of the block. The major advantages of neuraxial opioids are the
preservation of preganglionic sympathetic function, postoperative
RESULTS analgesia and augmentation of spinal .This study had shown that addition
There was no significant difference in mean Onset of Sensory Block and of fentanyl to low dose of bupivacaine provided the same level of
motor block between two groups. anaesthesia as that of higher dose of bupivacaine given alone with added
78.5 78 advantage of haemodynamic stability. This combination can be especially
80 useful for patients having ischaemic heart disease, diabetics with end
70 organ damage, renal failure without coagulopathy and in patients with
60 autonomic neuropathy. Results from our study shows that the baricity of
50
the solution does not make any difference to the level of blockade or the
mean time

40.1 39.3
(seconds)

SENSORY BLOCK
40 MOTOR BLOCK density of blockade which is similar to the results of the study done by Roy
30
G Soto et al.1
20
  CONCLUSION
10

0 Thus we conclude that adding fentanyl helps in reducing the dose of

A B
bupivacaine for spinal anaesthesia in below umbilical surgeries without
There was significant difference in mean Duration of sensory and motor showing any significant change in sensory and motor level block. It
block between two groups. provides better intra and postoperative analgesia, good hemodynamic
140 124.83 stability with no incidence of complications.
113 111
120 101.33 REFERENCES
100
1. Soto RG, Paez JC, Smith RA. Impact of baricity of bupivacaine on
mean time
(minutes)

80 SENSORY BLOCK intrathecal fentanyl-associated pruritus during combined

MOTOR BLOCK
60 spinal/epidural anesthesia for labor. The Internet Journal of
40 Anaesthesiol 2009;20(1):1-6
20 2. Kotwani, M.B, Rupwate, K., Shivananda, P., & Magar, J. Comparison
0 between high dose hyperbaric Bupivacaine (12.5 mg) alone versus
A B
low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in
There was no significant difference in Maximum Height of Block spinal anaesthesia for inguinal hernia surgery. International journal
between two groups. In Group A, 6.67% had T6 level, 43.33% had T8 of clinical trials,2016,08: 3(3), 140.
block and 50% had T10 block. In Group B, .67% had T6 level, 3. Shah S, Shah B, Deb C. A study of comparative evaluation of
53.33% had T8 block and 40% had T10 block. There was significant bupivacaine plain versus bupivacaine with fentanyl in spinal
difference in mean Two Segment Regression between two groups. ( anaesthesia in geriatric patients. International Journal of Medical
Group A= 43.17 ± 3.43 min, Group B= 47.97 ± 4.48 min) and Health Research. 2016;2:23-26.
RESEARCH POSTER PRESENTATION DESIGN © 2012

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