Author(s): Naresh Bhukya1, Madhavi2, Pavani Kalyanam3, Pandu Naik3
Various adjuvants have been added to bupivacaine to shorten the onset of block and prolong the duration of block. Present study was undertaken to compare the efficacy of intrathecal fentanyl or buprenorphine with bupivacaine for all infraumbilical surgeries.
MATERIALS AND METHODS
100 ASA I and II patients of both sexes posted for various infraumbilical surgeries were chosen for the study and the patients were divided into two groups of 50 each. Group F received 3mL of 0.5% bupivacaine heavy with 0.5mcg/kg of fentanyl and groupB received 3mL of 0.5% bupivacaine heavy with 2mcg/kg of buprenorphine. The time of onset of sensory block was tested with pinprick method and motor block was assessed by onset of Bromage scale 3 and it was found that the onset of sensory block with buprenorphine was earlier compared to fentanyl.
Bradycardia observed in Group B in 7 patients (14%), which was successfully treated with vagolytic agents. In Group B, it was observed that there was hypotension in 14 patients (28%), and in Group F, 7 patients developed hypotension, which was successfully treated with vasopressors. Also, few patients developed pruritus, nausea and vomiting, which were negligible. Intraoperatively, sedation score was assessed using modified Ramsay. Sedation scale and there was higher incidence of sedation with buprenorphine group. Regression of motor block to Bromage0 was observed and the time to regression was significantly prolonged to 205±37.71 in the buprenorphine group, while it was 152.90±8.31 in the fentanyl group. Postoperatively, VAS scores were significantly low for the buprenorphine group when compared with fentanyl.
To summarise, buprenorphine has higher efficacy with intrathecal bupivacaine with prolonged duration of sensory and motor blockade with decreased incidence of side effects, better haemodynamic stability and intraoperative sedation and also analgesic sparing effect in the postoperative period when compared to fentanyl.