The Combination of Low-Dose Levobupivacaine and Fentanyl for Spinal Anaesthesia in Ambulatory Inguinal Herniorrhaphy

Abstract

This study investigated whether the addition of 25 microg intrathecal fentanyl to levobupivacaine spinal anaesthesia for outpatient inguinal herniorrhaphy allows a sub-anaesthetic levobupivacaine dose to be used. Forty patients were assigned to receive 5 mg levobupivacaine 0.5% mixed with 25 microg fentanyl (group LF) or 7.5 mg levobupivacaine 0.5% (group L). The highest sensory block levels achieved were T7 (range T5 - T9) and T6 (range T4 - T9) in groups LF and L, respectively. The times to two-segment regression, S2 regression, ambulation, urination and discharge were all significantly shorter in group LF than group L. These results indicate that, for outpatient inguinal herniorrhaphy, intrathecal fentanyl combined with low-dose levobupivacaine provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. This protocol is well suited for the outpatient setting because it features rapid recovery of full motor power, sensory function and bladder function.

Low-dose ropivacaine or levobupivacaine walking spinal anesthesia in ambulatory inguinal herniorrhaphy

“…The advantages of an awake patient, minimal drug costs, and rapid patient turnover has made this the method of choice for many surgical procedures. However, spinal anesthesia for hernia repair is more complicated; a higher level of sensory block is required, but increasing the dose of long-acting local anesthetics may produce extensive sensory and motor block as well as arterial hypotension, resulting in delayed discharge from hospital [5]. Ropivacaine and levobupivacaine are quite new among local anesthetics.…”

İnguinal herni tamiri sonrası postoperatif ağrı üzerinde intratekal fentanil ve intratekal morfinin etkilerinin karşılaştırılması

“…Some studies with fentanyl were performed to reduce the dose of local anesthetic used for IHR. The addition of 25 µg intrathecal fentanyl to low-dose levobupivacaine (5 mg) or low dose bupivacaine (7.5 mg) provided an adequate quality of spinal anesthesia and postoperative pain relief 9,10 .…”

Spinal Anaesthesia for Ambulatory and Short-Stay Plastic Surgery Procedures

“…[64,65] Smaller doses with added adjuvants have been reported for ambulatory cases; in gynecological patients 3 mg along with 10 µg fentanyl may be used safely,[66] 5 or 7.5 mg 0.5% intrathecal levobupivacaine plus fentanyl 25 µg for ambulatory patients undergoing inguinal herniorraphy provides good quality spinal anaesthesia and minimizes the need for intra-operative analgesia. [67] In a double-blinded study Sanansilp et al [68] compared spinal isobaric or hyperbaric 0.42% levobupivacaine. They found that hyperbaric levobupivacaine spread higher than the isobaric form, suggesting that the former is more predictable.…”