Intrathecal Ropivacaine versus Ropivacaine plus Fentanyl for Out-patient Arthroscopic Knee Surgery

Abstract

We evaluated the effects of low-dose intrathecal ropivacaine with or without fentanyl for arthroscopic knee surgery. Fifty patients were randomized in equal groups to receive an intrathecal solution (3 ml) containing either 10 mg isobaric ropivacaine or 8 mg isobaric ropivacaine plus 25 pg fentanyl. Complete motor blockade occurred in 22 patients (88%) in both groups. The time taken to reach sensory blockade to T10 and total motor blockade was shorter in the ropivacaine-treated group, but differences were not statistically significant. The duration of sensory and motor blockade was shorter in the ropivacaine plus fentanyl-treated group. The cephalad spread of sensory blockade was higher with ropivacaine than with ropivacaine plus fentanyl. We conclude that although 25 microg fentanyl added to 8 mg ropivacaine provided shorter motor and sensory blockade durations than 10 mg ropivacaine alone, small doses of ropivacaine plus fentanyl can be used safely for arthroscopic knee surgery.

Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-analysis of randomized trials

“…Trials were published between 1992 and 2012 and included data on 1393 patients, 733 of whom received intrathecal opioids (Table 1) [1,[3][4][5][6][7][8][11][12][13][14]22,[24][25][26][27]29,30,32,34,35,38,39,[42][43][44][45][46]. The median group size was 20 patients (range, 10-60 patients).…”

“…In the other 17 reports, there was a large variety of working hypotheses: different analgesic efficacy and different risks of adverse effects with experimental interventions [1,3,8,11,14,26,32,44]; improved analgesia and fewer adverse effects [13,25]; improved analgesia and equal risk of adverse effects [30]; equal analgesia and equal risk of adverse effects [22]; fewer adverse effects with no statement about analgesic efficacy [6,29,45]; and improved analgesia and potentially increased risk of adverse effects [27,35]. Selection of the LA dose in controls was based on literature findings in 6 reports [7,12,26,38,43,45], on previous personal findings in 2 [24,29], but unclear in the remaining 18 (64%).…”

Effects of fentanyl on isobaric ropivacaine in subarachnoid anaesthesia for lower abdominal and lower extremity surgeries

“…These results were in accordance with the Kaushik rao et al, Boztug et al and Sanli et al proved that fentanyl do not alter the motor effects of ropivacaine spinal anaesthesia. [11][12][13] Postoperative analgesia requirements in this study prolonged significantly in fentanyl group. The total analgesic requirements also decreased.…”

“…Similarly, Kaushik rao et al, Boztug et al Sanli et al and Layek et al found that time for analgesic requirement prolonged in fentanyl group compared to control group. [11][12][13]17,18 Intraoperative hypotension seen in 5 patients (3 in R vs2in RF), postoperative shivering in 4 patients (2 in each group), pruritus in one patient of RF group. Koltka et al reported 20% of patients who received ropivacaine with fentanyl had hypotension and 3% had bradycardia.…”

“…In our study, there was no significant difference in the mean onset time for T10 level of blockade between the two groups however Boztug et al studied the effects of intrathecal ropivacaine and intrathecal ropivacaine with fentanyl for out-patient arthroscopic knee surgery. 12 10 mg (3 ml) of the isobaric ropivacaine was compared with 8 mg isobaric ropivacaine combined with 25 μg fentanyl. The onset for T10 level of blockade was faster in Group R compared to Group RF (3.60±1.84 min vs. 5.25±2.04 min), but the results were not statistically significant.…”