Comparative evaluation of Intrathecal Fentanyl with different doses of Bupivacaine on lower limb surgery

Radhe Sharan, Vishal Jarewal, Harjeet Singh, Joginder Pal Attri


Introduction: Intrathecal administration of opioids and local anaesthetics provides good analgesia. Fentanyl potentiates the afferent surgical blockade and improves both intra and post operative analgesia. The synergism between intrathecal opioids and local anaesthetics achieves a reliable spinal anaesthesia with minimal hypotension. The optimal doses and dilutions of intrathecal combination of bupivacaine and fentanyl remain a subject of discussion. Therefore, we designed this study to compare the effects of different doses of hyperbaric bupivacaine 0.5% (10 mg, 12.5 mg, 15 mg) with fentanyl 25 microgram in subarachnoid block on quality of anaesthesia and recovery. Objectives: To observe sensory and motor blockcharacteristics and effects of different doses of bupivacaine on haemodynamic parameters. Method: A prospective randomized study was carried out on three groups of 20 each. Group A patients were given 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 µg and 0.9% normal saline 1.5 ml. Group B patients were given with 0.5% hyperbaric bupivacaine 12.5 mg, fentanyl 25 µg and 0.9% normal saline 1ml. Group C patients were given 0.5% hyperbaric bupivacaine 15 mg, fentanyl 25 µg and 0.9% normal saline 0.5 ml. Results: Duration of sensory block was prolonged in group C (139.50±16.05 minutes) than group A (129.00±18.32 minutes). On statistical comparison, group B and C (126.25±15.29 minutes and 132.75±10.70 minutes respectively) had significant prolonged duration of motor block than group A (114.00±18.11 minutes). Conclusion: Fentanyl 25µg with 0.5% hyperbaric bupivacaine 12.5 mg is superior in terms of characteristics of sensory and motor block and haemodynamic stability.

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Kehlet H, Rung GW, Callesen T. Postoperative opioid analgesia: time for a reconsideration? J Clin Anesth. 1996 Sep;8(6):441-5.

Dripps RD and Vandam LD. Long term follow up of patients who received 10,098 spinal anaesthesic: failure to discover major neurological sequelae. JAMA 1954; 156:1484.

Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron GP. Spinal anesthesia in outpatientknee surgery: 22- gaugeversus 25-gauge Sprotteneedle. Anesth Analg. 1995 Jul; 81(1):73-9.

Covino BG. Pharmacology of local anaesthetic agents. Br J Anaesth. 1986 Jul;58(7):701-16.

Kartha RK, Velamatis, Penas L, Aravapalli R, Lavine L. Epidural butorphanol for postoperative analgesia. Anaesthesiology 1987;67:A235.

Paterson GM, McQuay HJ, Bullingham RE, Moore RA. Intradural morphine and diamorphine. Dose response studies. Anaesthesia. 1984 Feb; 39(2):113-7.

Dickenson AH. Mechanisms of the analgesic actions of opiates and opioids. Br Med Bull. 1991 Jul;47(3): 690-702.

Hunt CO, Datta S, Hauch M, Ostheimer GW, Hesting L, Naulty JS. Perioperative analgesia with subaracjnoid fentanyl – bupivacaine. Anaesthesiology 1987;67:A621.

Ben-David B, Maryanovsky M, Gurevitch A, Lucyk C, Solosko D, Frankel R, Volpin G, DeMeo PJ. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg. 2000 Oct;91(4):865-70.

Lee BB, Ngan Kee WD, Hung VYS, Wong ELY. Combined spinal epidural in labor: Comparison of two doses of intrathecal bupivacaine with fentanyl. Br J Anaesth 1999;83(6):868-71.

Singh C, Trikha A and Saxena A. Spinal anaesthesia with bupivacaine and fentanyl.Anaesthesiaand clinical pharmacology 1999;15:291-94.

Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean section and in early postoperative period. Indian J Anaesth 2002; 46(6):469-72.

Akerman B, Arwestrom E, Post C. Local anaesthetics potentiates spinal morphine antinociception. Anaesthesia Analgesia 1988;67:943-48.

Fernandez-Galinski D, Rué M, Moral V, Castells C, Puig MM. Spinal anesthesia with bupivacaine and fentanyl in geriatric patients. AnesthAnalg. 1996 Sep;83 (3): 537-41.

Roussel JR, Heindel L. Effects of intrathecal fentanyl on duration of bupivacaine spinal blockade for outpatient knee arthroscopy. AANA J. 1999 Aug;67(4): 337-43.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT, Helenius HY, Kirvelä OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg. 2000 Dec;91(6):1452-6.

Wang C, Chakrabarti MK, Whitman JG. Specific enhancement by fentanyl of effects of intrathecal bupivacaine on nociceptive afferent but not on efferent pathways in dogs.Anaesthesiology1993;79:766-73.

Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, Pollock JE. Fentanyl prolongs lidocainespinal anesthesia without prolonging recovery. Anesth Analg. 1995 Apr;80(4):730-4.

Herman NL, Choi KC, Afflek PJ, Calocott R, Braklin R, Singhal A, Andreasen A, Gadalla F, Fong J, Gomillion MC, Martman JK, Koff HD, Lee SHR, Decar TKV. Analgesia, pruritis and ventilation exhibit a dose – response relationship in parturients receiving intrathecal fentanyl during caesarean section. Anaesth Analg 1999;89:378-83.

Varrassi G, Celleno D, Capogna G, Costantino P, Emanuelli M, Sebastiani M, Pesce AF, NivD. Ventilatory effects of subarachnoidfentanyl in the elderly. Anaesthesia. 1992 Jul;47(7):558-62.


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