Karthi Vellakalpatti Mani, Arunpandiyan Veerapandiyan, Shankar Radhakrishnan
Bupivacaine is the widely used anaesthetic agent for spinal anaesthesia. Though, it has some advantages of producing good surgical anaesthesia and a longer half-life when compared to other local anaesthetics,the incidence of adverse effects on haemodynamic stability like hypotension was found to be more common. Adjuvants like opioids have been used in combination with bupivacaine to lower the dose of each agent and maintain the analgesic efficacy and thereby reducing the incidence and severity of adverse effects.Fentanyl, a lipophilic opioid, has rapid onset and offset of action. The aim of the study is to compare the efficacy and the incidence of adverse effects between bupivacaine alone and lowdose bupivacaine with fentanyl as spinal anaesthesia among the patients undergoing lower limb surgeries.
MATERIALS AND METHODS
A prospective longitudinal study was conducted for a period of one year in the Anaesthesiology Department at Vinayaka Mission Kirupananda Variyar Medical College Hospital. A total of 80 patients were included for the study. They were divided into two groups of 40 each, group H (bupivacaine 75 mg, n=40) and group L (bupivacaine 5 mg with 25 mg fentanyl, n=40). The patients were positioned in left lateral position and under sterile precautions 23G Quincke spinal needle was inserted between the L3 and L4 interspace, and depending on the patients allotted group, the anaesthetic agent was administered. Blood pressure, pulse rate, respiratory rate and saturation was recorded at 2 minute intervals for the first 10 minutes and then subsequently at 5 minutes interval. Adverse events such as nausea, vomiting, shivering, pruritus, respiratory depression and transient neurological symptoms if occurred were noted.
The maximum sensory level attainment was T9 in both the groups. The Bromage motor score was significantly higher in the fentanyl with low-dose bupivacaine group. The mean reduction of BP was higher among the patients who received high dose of bupivacaine and the difference was found to be statistically significant. No adverse events were reported in both the groups.
The combination of low-dose bupivacaine with fentanyl can be a preferred alternative for elective lower limb surgeries than a high dose of bupivacaine alone.