Comparison between high dose hyperbaric Bupivacaine (12.5 mg) alone versus low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in spinal anaesthesia for inguinal hernia surgery
Abstract:<p class="abstract"><strong>Background:</strong> For performing inguinal hernia surgeries, giving spinal anesthesia is a well known technique as it easy and provides fast onset, effective sensory and motor blockade in an awake patient. Now-a-days Bupivacaine is gaining importance as an effective spinal anaesthetic agent in combination with opioid analgesic Fentanyl to reduce the postoperative pain and side effects associated with surgery. This study aims to compare the effectiveness of intrat… Show more
“…There were no incidences of vomiting. There was no respiratory depression among the three study groups which was in accordance with the studies of Belzarena et al, 30 Singh et al, 3 Ben David et al 4 and Kotwani et al 31 Itching was significantly seen in patients receiving 25mcg of fentanyl (p value<0.05) which was also seen in the study conducted by Hunt et al, 1 Belzarena et al, 30 Ali et al 11 The incidence of side effects except hypotension were more commonly seen in group using 25 mcg of fentanyl. The strength of the study is that this study is one of the few studies which compared the effect of three doses (15 mcg, 20 mcg, 25 mcg) of fentanyl as an adjuvant with bupivacaine heavy (7.5 mg) as local anaesthetic during spinal anaesthesia for caesarean section.…”
BACKGROUND Spinal anaesthesia is the technique of choice for caesarean section as it is devoid of many potential problems associated with general anaesthesia. The usual dose required for reaching the desired block height for hyperbaric bupivacaine is 10-12 mg. A lower dose of bupivacaine with an adjuvant is used as a reliable combination which produces synergistic effect, prolonging the duration of sensory block without increasing sympathetic block or delaying recovery. METHODS A total of 110 patients undergoing elective or emergency Caesarean section under spinal anaesthesia, were screened for eligibility and 105 were randomised in the trial, allocated to 3 groups to receive injection bupivacaine 7.5 mg along with fentanyl 15 mcg (Group BF1, n=35), fentanyl 20 mcg (Group BF2, n=35), fentanyl 25 mcg (Group BF3, n=35). RESULTS The average time required to reach the block height of T4-T6 was around 3.26 min in BF1, 3.97 min in BF2, 4.63 min in BF3. The two-segment regression time of BF1 was 68.06 min; BF2 72.17 min and BF3 80.06 min. The recovery time of sensory block for BF1 is around 129.71 min, for BF2, 193.43 min and for BF3 200.86 min. The time for onset of motor block was BF1 1.49 min, BF2 1.51 min and BF3 2.34 min. The time to maximum of motor block was 2.8 min for BF1, 3.69 min for BF2, 7.8 min for BF3. The recovery time of motor block for BF1, was 107.14 min; BF2, 91.57 min and BF3, 65.66 min. CONCLUSIONS All the three doses of fentanyl-15mcg, 20mcg, 25mcg can be used as an adjuvant to 7.5 mg of 0.5% heavy bupivacaine for caesarean section to provide good quality surgical anaesthesia. Larger fentanyl dose group (25mcg) scores over small dose group in terms of sensory block with prolonged post-operative analgesia, early motor recovery and lesser incidence of hypotension.
“…There were no incidences of vomiting. There was no respiratory depression among the three study groups which was in accordance with the studies of Belzarena et al, 30 Singh et al, 3 Ben David et al 4 and Kotwani et al 31 Itching was significantly seen in patients receiving 25mcg of fentanyl (p value<0.05) which was also seen in the study conducted by Hunt et al, 1 Belzarena et al, 30 Ali et al 11 The incidence of side effects except hypotension were more commonly seen in group using 25 mcg of fentanyl. The strength of the study is that this study is one of the few studies which compared the effect of three doses (15 mcg, 20 mcg, 25 mcg) of fentanyl as an adjuvant with bupivacaine heavy (7.5 mg) as local anaesthetic during spinal anaesthesia for caesarean section.…”
BACKGROUND Spinal anaesthesia is the technique of choice for caesarean section as it is devoid of many potential problems associated with general anaesthesia. The usual dose required for reaching the desired block height for hyperbaric bupivacaine is 10-12 mg. A lower dose of bupivacaine with an adjuvant is used as a reliable combination which produces synergistic effect, prolonging the duration of sensory block without increasing sympathetic block or delaying recovery. METHODS A total of 110 patients undergoing elective or emergency Caesarean section under spinal anaesthesia, were screened for eligibility and 105 were randomised in the trial, allocated to 3 groups to receive injection bupivacaine 7.5 mg along with fentanyl 15 mcg (Group BF1, n=35), fentanyl 20 mcg (Group BF2, n=35), fentanyl 25 mcg (Group BF3, n=35). RESULTS The average time required to reach the block height of T4-T6 was around 3.26 min in BF1, 3.97 min in BF2, 4.63 min in BF3. The two-segment regression time of BF1 was 68.06 min; BF2 72.17 min and BF3 80.06 min. The recovery time of sensory block for BF1 is around 129.71 min, for BF2, 193.43 min and for BF3 200.86 min. The time for onset of motor block was BF1 1.49 min, BF2 1.51 min and BF3 2.34 min. The time to maximum of motor block was 2.8 min for BF1, 3.69 min for BF2, 7.8 min for BF3. The recovery time of motor block for BF1, was 107.14 min; BF2, 91.57 min and BF3, 65.66 min. CONCLUSIONS All the three doses of fentanyl-15mcg, 20mcg, 25mcg can be used as an adjuvant to 7.5 mg of 0.5% heavy bupivacaine for caesarean section to provide good quality surgical anaesthesia. Larger fentanyl dose group (25mcg) scores over small dose group in terms of sensory block with prolonged post-operative analgesia, early motor recovery and lesser incidence of hypotension.
“…Majority of researchers have reported incidence ranging from 0%-35% in low dose group and higher incidence of 41% in patients where higher dose of local anaesthetic use. [1,2,9,12,13,18] The other side effects like pruritits, nausea and shivering were not observed in any of the patients unlike other studies where few side effects were reported with the use of opioid adjuvant. [1,6,7,9,12,17] Thus the study highlighted the adequacy of sensory and motor blockade of more than 2 hrs duration with lower incidence of hypotension and vasopressor use there by proving the efficacy of 7.5 mg bupivacaine with fentanyl for better patient outcomes.…”
Section: Discussionmentioning
confidence: 58%
“…[1,2,9,12,13,18] The other side effects like pruritits, nausea and shivering were not observed in any of the patients unlike other studies where few side effects were reported with the use of opioid adjuvant. [1,6,7,9,12,17] Thus the study highlighted the adequacy of sensory and motor blockade of more than 2 hrs duration with lower incidence of hypotension and vasopressor use there by proving the efficacy of 7.5 mg bupivacaine with fentanyl for better patient outcomes. Hence the results can be extrapolated to other surgery of this duration in elderly (like inguinal surgery, fractures etc)…”
Section: Discussionmentioning
confidence: 58%
“…to 4.5 hrs was observed by kuusniemi et al [7] and in a metaanalysis by Sirivanasandha et al [14] when they studied patients receiving 7.5 mg bupivacaine with fentanyl. Kotwani and Dalvi et al [12,10] though reported slightly less time of 2 hrs sensory block in their respective studies but the duration was assessed till the level of sensory block receded to L1 in their study as against S2 level studied in rest of the studies including ours.…”
Section: Discussionmentioning
confidence: 67%
“…Kotwani M et al checked the onset every 5min hence could have reported longer time of onset of anaesthesia of 9.8 min in patients receiving 7.5mg bupivacaine with 25 µgm fentanyl. [12] The height of anaesthesia required for such surgeries is generally at T10 level. we observed that.…”
Background:The major drawback of spinal anesthesia in elderly patients is the per operative hypotension and its sequel. We compared two doses (7.5 mg or 10 mg) of hyperbaric bupivacaine 0.5% with 25µg fentanyl in 150 elderly patients undergoing routine urological surgery with respect to hemodynamic profile.
Results:The time to onset of sensory block (min) was comparable amongst the two groups (2.41±0.86 and 2.25±0.79) in group A and B respectively. The mean time to regression of block to S2 level was at 3.56±0.53 hrs. in group A and 4.01±0.71 hrs in group B (p<0.0001). The maximum mean height of sensory block was at T8 level in 73.3% patients and T10 level in 18.6% patients of group A. In group B patients 58.6% had the sensory level at T6 level in 33% patients it was at T8 and in 8% it was at T4 level (p<0.0001). Onset of motor block was earlier in group B and was at 3.89±0.8 min over 4.23±1.01in group A. (p=0.026). The time to regression of motor block was earlier in group A (4.07±o.54 hrs over 4.69±0.58 hrs in group B). (p<0.0001). The decrease in MAP from baseline values was more in group B over group A (0% vs. 4.7%, p<0.05) but the incidence of hypotension and bradycardia were statistically comparable amongst the groups (p>0.05).
Conclusion:The use of 7.5mg bupivacaine with 25 µg fentanyl intrathecally results in adequate anaesthesia and analgesia coupled with stable hemodynamic as required for transurethral surgery of around 2 hrs.duration.
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