The Use of Bupivacaine and Fentanyl for Spinal Anesthesia for Urologic Surgery

Abstract

We evaluated the effect of 25 microg of fentanyl added to bupivacaine on sensory and motor block. By using a double-blinded study design, 80 men undergoing urologic surgery were randomized into the following four groups: Group I, bupivacaine 10 mg; Group II, bupivacaine 10 mg + fentanyl 25 microg; Group III, bupivacaine 7.5 mg + fentanyl 25 microg; Group IV, bupivacaine 5 mg + fentanyl 25 microg. The final volume of intrathecal injectate was adjusted to 2. 5 mL with sterile distilled water. Spinal anesthesia was administered with the 27-gauge Whitacre needle at the L2-3 interspace with the patient in the sitting position. Neural block was assessed by using pinprick and a modified Bromage scale. The degree of motor block was more profound in Group II compared with Group I at the end of operation. In Group IV, there was no motor block at the end of operation in any of the patients. The median level of the upper limit of the sensory block was higher than T(7) in all groups before the start of surgery. The addition of 25 microg of fentanyl to 5 mg of bupivacaine resulted in short-acting motor block. When 25 microg of fentanyl was added to 10 mg of bupivacaine, it increased the intensity and duration of motor block. Only 5 (6. 3%) of the patients needed supplemental analgesia during the operation. ¿abs¿

Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study

“…Pain is frequently encountered during surgery on the female genital organs under spinal local anesthetics, intrathecal fentanyl when added to spinal local anesthetics reduces significantly visceral and somatic pain and this analgesic effect has been proved by many studies [11][12][13][14] . Intrathecal fentanyl prolongs the duration of spinal anesthesia produced by bupivacaine and lignocaine and this effect has been shown in obstetric and non-obstetric patients undergoing various surgeries [15,16] . The prolongation of the duration of spinal analgesia produced by intrathecal fentanyl is not a dose related.…”

“…Seewal et al [3] found a significant improvement in the duration and quality of analgesia produced by intrathecal fentanyl and bupivacaine compared to intrathecal bupivacaine alone, meanwhile, the author found no further increase in the duration of analgesia when the dose of fentanyl was increased from 10 µg to 20, 30, or 40 µg. Kuusniemi et al [15 ] reported that different durations of spinal anesthesia were related to different doses of spinal bupivacaine supplemented with 25 µg fentanyl in patients undergoing urology procedures. Hamber et al [17] in a review article found that a dose of 20-30 µg fentanyl as adjunct to spinal anesthesia produces faster block onset time, improved intraoperative analgesia and decrease incidence of intraoperative nausea and vomiting in obstetric patients.…”

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

“…We contacted the corresponding authors of 25 trials to obtain additional information; and were eventually able to include additional data from 6 trials [2,34,35,39,47,61].…”

“…Seven trials (7 comparisons) tested fentanyl 10 to 40 lg added to bupivacaine and reported on presence or absence of respiratory depression [18,31,44,47,66,70,76] (Table 2). None of 180 patients receiving bupivacaine alone and 1 of 245 (0.4%) receiving bupivacaine with fentanyl had respiratory depression.…”

“…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%.…”