European Journal of Molecular & Clinical Medicine

Background:This clinical study was undertaken to compare the effects of intrathecal
midazolam and fentanyl as additives to intrathecal bupivacaine 0.5 % for spinal
anaesthesia.
Materials and Methods: This prospective, randomized, comparative study was
conducted on 100 adult patients of ASA physical status 1 & 2 in the age group of 18
years to 60 years, at MAMATA GENERAL HOSPITAL, KHAMMAM. on patients
admitted for elective surgery from the period october 2017 - september 2019. Patients
belonging to Group A received 3 ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.2 ml
(1 mg) of preservative free midazolam + 0.3 ml of normal saline and Group B received 3
ml (15 mg) of hyperbaric bupivacaine (0.5 %) + 0.5 ml (25 μg) of fentanyl. Patients were
preloaded with intravenous Ringer’s lactate solution 15 ml / kg just before
administering subarachnoid block. Subarachnoid block was administered in L3-L4
intervertebral space with 25G Quincke’s needle. Standard monitoring was carried out
in the form of pulse oximetry, ECG and non-invasive arterial blood pressure
monitoring. Pulse rate, respiratory rate, arterial blood pressure and oxygen saturation
were recorded every 5mins for first 10mins, every 10mins for next half an hour and
then every 15mins intra operatively. The following parameters were observed - onset
and duration of sensory blockade, maximum level of sensory blockade achieved, two
segment regression, onset and duration of motor blockade, duration of effective
analgesia and any side effects associated with these drugs like nausea, vomiting,
pruritis, bradycardia, and hypotension. Computer generated randomization was used
to allocate patients into two groups. Statistical analysis was done using T-test and
fischers exact test. P value of less than 0.05 was considered to be significant
Results: The present study concludes that there were no differences in the onset of
sensory and motor blockade, maximum level of sensory blockade achieved, and time for
two segment regression. 25μg intrathecal fentanyl was found to provide a longer
duration of sensory and motor blockade and prolonged the time for first rescue
analgesia as compared to 1mg intrathecal midazolam. There was no significant
difference between the two groups with respect to the occurrence of side effects.
Conclusion: Hence, we suggest that addition of intrathecal fentanyl is excellent additive
to Bupivacaine for prolongation of duration of anaesthesia without any deleterious
effects.

Introduction: Spinal anaesthesia is simple, rapid and most reliable anaesthetic technique. It is the most common regional anaesthesia technique, practiced worldwide. It is an efficient technique, which is easy to perform. However, associated with side effects like hypotension, bradycardia and also post-operative nausea, vomiting and chills. Decrease in vascular resistance caused by sympathetic blockade leads to drop in arterial pressure. Bradycardia is caused due to parasympathetic over activity, increase in baroreceptor activity and Bezold Jarish reflex (BJR). Ondansetron is a well-tolerated drug with 5HT3 antagonising effects which is used most commonly for peri-operative nausea and vomiting with minor side effects. Ondansetron poorly penetrates the blood brain barrier with minimal influence on central serotogenic mechanisms. Hence has less chances of causing cognitive side effects like headache, agitation and confusion. The objectives of this study is to assess the effect of intravenous ondansetron on spinal anaesthesia induced hypotension and bradycardia and the effect of ondansetron on Peri-operative nausea, vomiting and chills.