Effect of fentanyl on low dose hyperbaric bupivacaine in comparison with hyperbaric ropivacaine for day care anorectal surgeries: A case comparative study
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 6, Pages 2409-2420
AbstractBackground: The core idea of 'day-care surgeries', or 'ambulatory surgeries', is to admit the carefully selected patients on the day of surgery, prepare them for the planned elective surgery and then discharge them on the same day to their familiar environment. (1) Day care surgeries are supposed to be more cost effective as compared to inpatient surgeries and also carry less risk of iatrogenic infections and also reduction in thromboembolism due to early mobilisation. (2) General principles of day care anaesthetic techniques include rapid/reliable onset and offset of effect from anaesthetic agents or procedures, early return of cognition and minimal PONV (Postoperative Nausea and Vomiting), dizziness and more importantly it should have minimum stress and provide maximum comfort to patient by early return to normalcy.(3)
Various adjuvants are added intrathecally to enhance the anaesthetic potential of local anaesthetic and also to provide better postoperative analgesia with minimal effect on motor blockade and thereby facilitate early discharge. (4, 5)
Conventionally hyperbaric bupivacaine has been used for these procedures. Recently hyperbaric Ropivacaine 0.75% which is an S enantiomer of propivacaine has been introduced which provides a favourable intraoperative anaesthetic condition with early mobilisation and recovery post operatively.
There are very few studies which have compared the synergistic effect of intrathecal fentanyl with hyperbaric bupivacaine in comparison to hyperbaric ropivacaine in day care perianal surgeries.
Methodology: Total 60 patients of ASA grade I and II posted for perianal surgeries were divided into 2 equal groups, group Bupivacaine and Group Ropivacaine by random generated numbers from computers. Using 26-gauge quinke needle, subarachnoid block was given wherein, Group Bupivacaine received 0.4 ml (2 mg) 0.5% Inj. Bupivacaine (hyperbaric) with 0.2 ml (10 ug) Fentanyl, whereas Group Ropivacaine received 0.4 ml (3 mg) 0.75% Inj. Ropivacaine (hyperbaric) with 0.2 ml (10 ug) Fentanyl and patient was made to sit for 5
minutes for saddle block.
Measurements: Haemodynamic variables like Pulse rate, Systolic pressure, Diastolic pressure, Mean Arterial Pressure, time of onset of sensory block, level and duration of sensory and motor block, Highest sensory level, time to reach Highest sensory level, time to voiding and ambulation, postoperative pain assessment by VAS scoring system, maximum postoperative analgesic consumption, Time of analgesic consumption, complications like nausea, vomiting, Pruritis, PDPH and patient satisfaction score were recorded.
Results: Hemodynamic parameters, highest sensory level, intensity of motor block, time of onset and time to reach highest sensory level, success rate, satisfaction score and complications were comparable in both the groups. Post-operative pain was assessed by VAS score which was comparable in both the groups. The duration of post-operative analgesics was prolonged in Group Bupivacaine (145 minutes) in comparison to Group Ropivacaine (116 minutes) though was not statistically significant. Post-operative ambulation was 248.41 minutes in Group Bupivacaine and 203.35 minutes in Group Ropivacaine and was statistically significant. (P value <0.05) Time to voiding was earlier in Group Ropivacaine (238.94 minutes) compared to Group Bupivacaine (284.14 minutes) and was statistically significantly (p= 0.000).
Conclusion: This study concludes that low dose of 0.75% hyperbaric Ropivacaine with 10 ug fentanyl in saddle block is a very good substitute for conventional local anesthetics for day care perianal surgeries.
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