Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-09T15:29:59.977Z Has data issue: false hasContentIssue false

Intrathecal fentanyl added to intrathecal bupivacaine for day case surgery: a randomized study

Published online by Cambridge University Press:  02 June 2005

S. Goel
Affiliation:
Postgraduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India
N. Bhardwaj
Affiliation:
Postgraduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India
V. K. Grover
Affiliation:
Postgraduate Institute of Medical Education and Research, Department of Anaesthesia and Intensive Care, Chandigarh, India
Get access

Extract

Summary

Background and objective: The implication of intrathecal lidocaine in neurological toxicity has made intrathecal bupivacaine the commonly used drug for local anaesthesia in ambulatory surgery. However, in high doses intrathecal bupivacaine may produce a high level of sensory and motor block, and arterial hypotension; discharge from hospital may be delayed. Intrathecal opioids added to low-dose local anaesthetics produce a synergistic effect without increasing the sympathetic block or delaying discharge. The aim of our study was to identify the minimum effective dose of intrathecal fentanyl that in combination with low-dose intrathecal bupivacaine would provide adequate surgical conditions without prolonging recovery.

Methods: A prospective, single, blind, randomized study was conducted in 45 adult males scheduled for minor urological procedures using intrathecal anaesthesia on a day care basis. Patients were randomly assigned to one of three groups (n = 15 each). They received bupivacaine 0.17% 5 mg – with either fentanyl 7.5 μg (fenta-7.5), 10 μg (fenta-10) or 12.5 μg (fenta-12.5) intrathecally in a total volume of 3 mL. The quality of anaesthesia, haemodynamic stability, time to two-segment and S2 regression, time to micturition, and time to discharge were assessed.

Results: The time to two-segment regression and S2 regression with fenta-12.5 was significantly longer than with fenta-7.5 and fenta-10 (P < 0.01). Fenta-7.5 had a significantly higher number of failed blocks (four patients) compared with fenta-12.5 (P < 0.05). The time out of bed, time to micturition and time to discharge were significantly longer with fenta-10 and fenta-12.5 compared with fenta-7.5, and also with fenta-12.5 compared with fenta-10 (P < 0.01). Haemodynamic stability did not differ for all the drug combinations.

Conclusions: Fentanyl 12.5 μg added to low-dose bupivacaine (5 mg) intrathecally provides better surgical anaesthesia and increased reliability of block than intrathecal fentanyl 7.5 or 10 μg. Haemodynamic stability was the same for all dose combinations used.

Type
Original Article
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Schneider M, Ettlin T, Kaufman M, et al. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg 1993; 76: 11541157.Google Scholar
Hampl K, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 11481153.Google Scholar
Drasner K, Sakura S, Chan VW, Bollen AW, Ciriales R. Persistent sacral sensory deficit induced by intrathecal local anesthetic infusion in the rat. Anesthesiology 1994; 80: 847852.Google Scholar
Nielsen TH, Kristoffersen E, Olsen KH, Larsen HV, Husegaard HC, Wernberg M. Plain bupivacaine 0.5% or 0.25% for spinal analgesia? Br J Anaesth 1989; 62: 164167.Google Scholar
Sheskey MC, Rocco AG, Bizzarri-Schmid M, Francis DM, Edstrom H, Covino BG. A dose response study of bupivacaine for spinal anesthesia. Anaesth Analg 1983; 62: 931935.Google Scholar
Ben-David B, Levin H, Soloman E, Admoni H, Vaida S. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996; 83: 716720.Google Scholar
Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology 1992; 76: 9199.Google Scholar
Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiology 1993; 79: 766773.Google Scholar
Ben-David B, Soloman E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997; 85: 560565.Google Scholar
Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine–fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000; 92: 610.Google Scholar
Choi DH, Ahn HJ, Kim MH. Bupivacaine sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med 2000; 25: 240245.Google Scholar
Chu CC, Shu SS, Lin SM, et al. The effect of intrathecal bupivacaine with combined fentanyl in cesarean section. Acta Anesthesiol Sin 1995; 33: 149154.Google Scholar
Bromage PR. A comparison of the hydrochloride and carbon dioxide salt of lignocaine and prilocaine in epidural analgesia. Acta Anesthesiol Scand 1965; 16: 5559.Google Scholar
Marshall Scott I, Chung F. Discharge criteria and complication after ambulatory surgery. Anesth Analg 1999; 88: 508517.Google Scholar
Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology 1992; 75: 11861200.Google Scholar
Hunt CO, Naulty JS, Bader AM, et al. Perioperative analgesia with subarachnoid fentanyl–bupivacaine for cesarean delivery. Anesthesiology 1989; 71: 535540.Google Scholar
Reuben SS, Dunn SM, Duprat KM, O'Sullivan P. An intrathecal fentanyl dose–response study in lower extremity revascularization procedures. Anesthesiology 1994; 81: 13711375.Google Scholar