Intrathecal fentanyl prolongs sensory bupivacaine spinal block

Singh, Harbhej; Yang, Jay How; Thornton, Katina; Giesecke, A. H.

doi:10.1007/bf03011070

Cited by 112 publications

(116 citation statements)

References 20 publications

(8 reference statements)

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“…The use of small gauge pencil point needles has improved the feasibility of spinal anaesthesia as it reduces the incidence of postspinal headache. 6,9 Use of high dose 12.5 mg, i.e. 2.5 cc of 0.5% hyperbaric Bupivacaine in spinal anaesthesia is routine for inguinal herniorrhaphy.…”

Section: Discussionmentioning

confidence: 99%

“…12 Hence, it is advisable for neuraxial administration of opioids in conjunction with local anaesthetics to improve the anaesthetic effect, quality of intraoperative analgesia and for prolonged duration of postoperative analgesia. [4][5][6]9 Animal studies have also demonstrated antinociceptive synergism between intrathecal opioids and local anaesthetic during visceral and somatic nociception. 9,13 In the present study, the aim of adding Fentanyl was to provide good surgical conditions without significant delay in recovery or increase in adverse effects with good postoperative analgesia in patients undergoing inguinal herniorrhaphy.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6]9 Animal studies have also demonstrated antinociceptive synergism between intrathecal opioids and local anaesthetic during visceral and somatic nociception. 9,13 In the present study, the aim of adding Fentanyl was to provide good surgical conditions without significant delay in recovery or increase in adverse effects with good postoperative analgesia in patients undergoing inguinal herniorrhaphy. Intrathecal Fentanyl has already shown to prolong the duration of local anaesthetic blockade in dose dependent manner.…”

Section: Discussionmentioning

confidence: 99%

“…Intrathecal Fentanyl has already shown to prolong the duration of local anaesthetic blockade in dose dependent manner. 5,[14][15][16] A combination of Bupivacaine 7.5 mg + Fentanyl 25 µg as a spinal anaesthesia proved to be safe and effective in relieving the intense pain associated with inguinal herniorrhaphy by the studies conducted by Gupta et al, H Singh et al, Song et al 7,9,17 Kuusniemi et al, also evaluated the effect of addition of 25 µg Fentanyl to various doses of Bupivacaine (10, 7.5, 5 mg) in urological surgeries, and found increase in the intensity and duration of sensory block by Fentanyl. 18 In our study, the earlier onset of surgical anaesthesia and peak sensory level in Group B may be because of cephalad spread of spinal blockade.…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2016

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Background: 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 intrathecal Bupivacaine alone versus combination of Bupivacaine with Fentanyl.Methods: The study designed was a prospective, randomized, double blinded comparative study. Patients were randomly divided into two groups of 25 each. Group B received hyperbaric intrathecal Bupivacaine 12.5 mg and Group BF received diluted hyperbaric intrathecal Bupivacaine 7.5 mg and Fentanyl 25 µg for spinal anesthesia . Parameters like sensory and motor block were assessed. Side effects produced during perioperative and postoperative period were observed and noted. Satisfactory criteria by the surgeons and patients were considered.Results: The time taken to attain surgical anesthesia and peak sensory levels in minutes was statistically significant in Group B compared to Group BF. Due to higher dose of Bupivacaine, it was observed that degree of motor blockade is also higher in group B when compared to group BF. The incidence of hypotension, nausea, vomiting and hypothermia are significantly higher in group B due to high dose of Bupivacaine. The surgeons and patients satisfaction was good in both the groups. Conclusions: Low dose Bupivacaine in combination with Fentanyl is safe and effective alternative for spinal anesthesia for inguinal herniorrphaphy as compared to conventional high dose Bupivacaine alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

et al. 2016

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“…Thirteen trials (17 comparisons) tested fentanyl 10 to 40 lg added to bupivacaine and reported on the incidence of postoperative pruritus [7][8][9]18,28,31,39,44,47,66,70,73,76] (Table 2; Supplemental Data 7). The average incidence of pruritus with bupivacaine alone was 0%.…”

Section: Pruritusmentioning

confidence: 99%

Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: A meta-analysis of randomized trials

Pöpping

Elia

Marret

et al. 2012

Pain

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a b s t r a c tOpioids are widely used as additives to local anesthetics for intrathecal anesthesia. Benefit and risk remain unclear. We systematically searched databases and bibliographies to February 2011 for full reports of randomized comparisons of any opioid added to any intrathecal local anesthetic with the local anesthetic alone in adults undergoing surgery (except cesarean section) and receiving single-shot intrathecal anesthesia without general anesthesia. We included 65 trials (3338 patients, 1932 of whom received opioids) published between 1983 and 2010. Morphine (0.05-2 mg) and fentanyl (10-50 lg) added to bupivacaine were the most frequently tested. Duration of postoperative analgesia was prolonged with morphine (weighted mean difference 503 min; 95% confidence interval [CI] 315 to 641) and fentanyl (weighted mean difference 114 min; 95% CI 60 to 168). Morphine decreased the number of patients needing opioid analgesia after surgery and decreased pain intensity to the 12th postoperative hour. Morphine increased the risk of nausea (number needed to harm [NNH] 9.9), vomiting (NNH 10), urinary retention (NNH 6.5), and pruritus (NNH 4.4). Fentanyl increased the risk of pruritus (NNH 3.3). With morphine 0.05 to 0.5 mg, the NNH for respiratory depression varied between 38 and 59 depending on the definition of respiratory depression chosen. With fentanyl 10 to 40 lg, the risk of respiratory depression was not significantly increased. For none of these effects, beneficial or harmful, was there evidence of dose-responsiveness. Consequently, minimal effective doses of intrathecal morphine and fentanyl should be sought. For intrathecal buprenorphine, diamorphine, hydromorphone, meperidine, methadone, pentazocine, sufentanil, and tramadol, there were not enough data to allow for meaningful conclusions.Ó

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