A STUDY TO DETERMINE THE EFFECTS OF INTRATHECAL FENTANYL COMBINED WITH 0.5% BUPIVACAINE (HYPERBARIC) FOR SUBARACHNOID BLOCK ON THE DURATION AND QUALITY OF POST-OPERATIVE ANALGESIA.

Corresponding Author:
Dr. Rahul Fernandez,
Senior Resident,
Department of Anaesthesiology and Critical Care,
St. John’s Medical College Hospital,
Sarjapur Road, Bangalore,
Karnataka, India.
E-mail: fernandezrahul06@gmail.com

ABSTRACT

BACKGROUND

Spinal anaesthesia with hyperbaric Bupivacaine Hydrochloride has been popular for surgical procedures. The need to intensify and increase duration of sensory blockade without affecting motor blockade has led to the addition of fentanyl, thus prolonging the duration of post-operative analgesia. Aim of this study is to assess the duration and quality of post-operative pain relief when Hyperbaric Bupivacaine Hydrochloride is combined with fentanyl for sub-arachnoid block and also to study the prolongation of motor and sensory blockade.

MATERIALS AND METHODS

75 patients were randomly allocated into the following three groups Group A received SAB with 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric) Group B received SAB with addition of 10mg fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric). Group C received SAB with addition of 25mg fentanyl to 2.5 ml of 0.5% Bupivacaine Hydrochloride (Hyperbaric).

RESULTS

Mean duration of analgesia was increased with addition of fentanyl with 0.5% hyperbaric Bupivacaine intrathecally. Mean duration of analgesia was statistically highly significant in the fentanyl groups. The total dose of analgesics given in the postoperative period was highest in group A which was statistically significant. Times for two segment regression of sensory level were prolonged in group B and group C thus increasing the duration of sensory analgesia. Time to full motor recovery was not delayed in any of the three groups. The haemodynamic changes were similar in all the three groups with minimal changes in pulse rate and systolic blood pressure.

CONCLUSION

The addition of intrathecal fentanyl to the local anaesthetic injected intrathecally in subarachnoid block prolonged sensory analgesia obtained by the block without hampering recovery from motor block or causing untoward haemodynamic disturbances. Dose of 10 mg fentanyl provided all these benefits which were accentuated by increasing the dose to 25mg. Hence a dose of 10 mg to 25 mg as deemed fit is useful for this purpose.

KEY WORDS

Bupivacaine, Fentanyl, Intrathecal, Postoperative Analgesia.