European Journal of Molecular & Clinical Medicine

Background: In this study, we wantedto compare the effectiveness of intrathecal Hyperbaric Ropivacaine with fentanyl and Hyperbaric Bupivacaine with fentanyl in perineal surgeries, to sensory block and motor block. We also compared the changes in blood pressure, heart rates and complications.
Materials and methods: This was a hospital based non-randomised control comparative study conducted among 40 patients posted for perineal surgeries to Osmania General Hospital, Afzalgunj, Hyderabad, over a period of 24 months after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants.
Results: The minimum and maximum (time of onset of motor blockade) TOM was 2 and 3 minutes in group ‘A’ and 1 and 2 minutes in group ‘B’. The mean ± SD TOM is 2.5 ± 0.51 minutes in group ‘A’ and 1.6 ± 0.51 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter time of onset of motor blockade. The minimum and maximum duration of sensory blockade (DOS) was 132 and 172 minutes in group ‘A’ and 96 and 140 minutes in group ‘B’. The mean ± SD DOS is 153.4 ± 11.94 minutes in group ‘A’ and 112.0 ± 13.86 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter DOS (in minutes). The minimum and maximum DOM was 165 and 198 minutes in group ‘A’ and 120 and 170 minutes in group ‘B’. The mean ± SD duration of motor blockade (DOM) was 185.2 ± 9.21 minutes in group ‘A’ and 155.8 ± 13.79 minutes in group ‘B’. There was significant difference between two groups A and B for the parameter DOM (in minutes).
Conclusion: Hyperbaric ropivacaine achieves a lesser duration of sensory and motor blockade, and lesser degree of motor blockade when compared with hyperbaric bupivacaine. Hence, hyperbaric ropivacaine with fentanyl in spinal anaesthesia is a better alternative for perineal day care surgeries

Background: Opioids and local anaesthetics act synergistically and it’s a popular technique to combine bupivacaine and fentanyl in spinal anaesthesia for caesarean delivery. The aim of the study was to find out optimal dose combination of bupivacaine and fentanyl for spinal anaesthesia for better quality of perioperative analgesia and reduction of feto-maternal adverse outcome during caesarean section.
Methods: Three hundred and four parturients scheduled for caesarean delivery were randomly allocated to four groups of 76 each. Data of 298 parturients (Gp I=73, Gp II=75, Gp III=75 and GP IV=75) was included in the primary outcome analysis. The control group received 12 mg of 0.5% hyperbaric bupivacaine for spinal anaesthesia. Fentanyl 15, 20 or 25 μg was added to each study group who received 9 mg of 0.5% hyperbaric bupivacaine in spinal anaesthesia. Onset and duration of spinal anaesthesia, hemodynamic parameters, intraoperative nausea & vomiting (IONV), failed block, APGAR score and other side effects were noted.
Results: The duration of effective and complete analgesia was significantly longer in all fentanyl groups. However, increasing the dose of fentanyl from 15 to 25 μg had little effect on further prolongation of analgesia. Duration of motor blockade was significantly prolonged in control group. The incidence of hypotension and IONV episodes were significantly low in the study groups.
Conclusion: Bupivacaine and fentanyl have super additive effect in spinal block. However, strict drug dose calculation is required in spinal anaesthesia to minimize adverse outcomes during caesarean delivery. Spinal anaesthesia with fentanyl 15 μg and 0.5% hyperbaric bupivacaine, 9 mg provides optimal surgical conditions for caesarean delivery with negligible side effects as compared to other dose combinations.