Haribabu, V (2007) Comparative Evaluation of subarachnoid block with low dose bupivacaine and fentanyl Vs Low dose bupivacaine and Sufentanil in patients undergoing inguinal surgeries. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Spinal anaesthesia is widely used for surgeries involving the lower limb, perineum and inguinal region. The duration of spinal anaesthesia that is timed according to the duration of surgery may help prevent complications associated with prolonged immobilization especially in elderly patients. Recently there has been an interest in using analgesics and local anaesthetics in an attempt to decrease the local anaesthetic dose enabling faster recovery while improving anaesthetic success and providing effective post operative analgesia. The use of intrathecal lignocaine for spinal anaesthesia has been questioned because of the frequent occurrence of Transient Neurological Symptoms. An increasing number of surgeries being performed in the ambulatory setting under spinal anaesthesia has generated interest in finding alternative drugs that would provide adequate surgical anaesthesia while having quick recovery profile and low side effect profile. The discovery of opioid receptors has opened new horizons in pain management. Since their introduction into clinical practice in 1979, spinal opioids have achieved great international popularity in a variety of clinical settings either as sole analgesic agents or in combination with low-dose local anesthetic agents. By bypassing blood and the blood-brain barrier, small doses of opioids administered in either the subarachnoid or epidural spaces provide profound and prolonged segmental analgesia. Numerous studies have shown that spinal opioids can provide profound postoperative analgesia with less central and systemic adverse effects than can opioids administered systematically. Several reviews have appeared in the literature. The rationale for the combination technique is that opioids and local agents eliminate pain by acting at two distinct sites—the local anaesthetic at the nerve axon and the opioid at the receptor site in the spinal cord. If even an extremely low concentration of local anaesthetic is added to the opioid, the quality of analgesia may be far superior. This study thus was designed to test the hypothesis that adding an opioid to the local anaesthetic in the subarachnoid space provides great advantages as has been reported extensively in literature. AIM OF THE STUDY: To study the effect of Low dose Hyperbaric Bupivacaine 10 mg with 5 μg of Sufentanil Vs. Low dose Hyperbaric Bupivacaine 10 mg with 50 μg of Fentanyl on: 1. Block characteristics, 2. Hemodynamic changes. MATERIALS AND METHODS: This study was conducted at Government General Hospital, Madras Medical College and Research Institute, Chennai – 600 003 between July 2006 to August 2006 on 50 patients of ASA Physical Status I and II undergoing Inguinal and below Inguinal region surgeries. The study was done after getting institutional approval. Written informed consent was obtained from all patients included in the study. Study Design: This study was done in a prospective double blind randomized manner. The patients were divided into two groups of twenty-five each . Patient meeting criteria incorporated into study, randomly allotted to either group by draw of lots. Group F: Patients in this group received 10 mg of 0.5% hyperbaric bupivacaine with 50 μg of Fentanyl added to a total volume of 3 ml. Group S: Patients in this group received 2 ml [10 mg] of 0.5% hyperbaric bupivacaine with sufentanil 5 μg [diluted with 5% dextrose] and volume made to 3 ml. The final volume of injected solutions was 3 ml in both the groups. In the study 0.5% Bupivacaine in 8% dextrose manufactured by SPM Drugs, Fentanyl citrate [Free] manufactured by PHARMACHEMICO laboratories, sufentanil manufactured by CORE HEALTH and the dilutent 5% dextrose prepared by IVES DRUG INDIA LTD was used. All solutions were prepared under aseptic precaution by the operation theatre incharge anaesthesiologist uninvolved in the administration of subarachnoid block or in the observation of patients. The specific gravity of the injected solution 1.008 and this was hyperbaric related to cerebrospinal fluid [1.006]. Selection of Cases: Inclusion Criteria: 1. Male and female patients in age group of 20-60 years undergoing elective Inguinal and below Inguinal region surgeries. 2. ASA I and II. Exclusion Criteria: 1. Patient’s refusal. 2. ASA physical status III, IV and V. 3. Deformity of vertebral column. 4. Neurological diseases. 5. Local sepsis. 6. Bleeding diathesis. Following observation were made: 1. Intrathecal opioids [either Fentanyl or sufentanil] in combination with low doses of local anaesthetic [10 mg of 0.5% bupivacaine] produced satisfactory sensory block of the lower abdomen. 2. The onset of sensory block was little earlier when bupivacaine was combined with sufentanil [7.4 min] than fentanyl [9.04 min]. 3. The mean duration of sensory block was almost the same when bupivacaine was either combined with fentanyl [142.8 min] or sufentanil [137.8 min]. 4. The mean duration of analgesia was significantly longer with bupivacaine combined with sufentanil [264.6 min] than with fentanyl 216.8. 5. The mean duration of motor block was shorter with sufentanil in combination with bupivacaine [90.8 min] than fentanyl-bupivacaine combination [131.6 min]. 6. The variation of heart rate, systolic blood pressure and diastolic blood pressure from the baseline in both the groups was not statistically significant establishing a hemodynamic stability of intrathecal opioid low dose local anaesthetic combination than intrathecal local anaesthetic alone. 7. The incidence of side effects was relatively low with both the combination with only pruritis emerging as the leading complication in the either of the groups. 8. The percentage of cases reporting nausea, vomiting was very few in either of the groups. 9. None of the cases in either of the groups was complicated by respiratory depression, sedation and urinary retention. 10.No neurological complication were observed in any of the patients. CONCLUSION: This study confirms the safety and efficacy of intrathecal low dose local anaesthetic opioid combination in patients undergoing surgeries of inguinal region region of intermediate duration. When compared to intrathecal bupivacaine fentanyl combination; intrathecal bupivacaine sufentanil combination provided prolonged post operative analgesia with a lesser duration of motor blockade thus allowing early post operative ambulation. Both the groups were comparable with regards to haemodynamic stability. The side effects of intrathecal opioids are not significant and can be easily managed.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative Evaluation ; subarachnoid block ; low dose bupivacaine ; fentanyl ; Low dose bupivacaine ;Sufentanil ; patients ; undergoing inguinal surgeries. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 21 Apr 2018 06:44 |
| Last Modified: | 21 Apr 2018 09:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7179 |
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