Abbi Pooja, Kumari Anita, Gupta Ruchi, Monga Nikhil, Kaur Harmandeep, Kullar Keerat Kaur
Department of Anaesthesia, SGRDIMSAR, Amritsar, Punjab, India.
Department of Internal Medicine, Parvati Devi Hospital, Amritsar, Punjab, India.
Anesth Essays Res. 2020 Apr-Jun;14(2):343-348. doi: 10.4103/aer.AER_58_20. Epub 2020 Oct 12.
Regional anesthesia is the preferred technique for most of lower abdominal and lower limb surgeries as it allows the patient to remain awake and minimize the problems associated with airway management. Hyperbaric bupivacaine 0.5%, although extensively used for spinal anesthesia, has a limitation of short duration. The addition of fentanyl, a synthetic lipophilic opioid, is known to prolong postoperative analgesia.
We aimed to study the effect of the addition of different doses of fentanyl to hyperbaric bupivacaine about hemodynamic changes, the extent of sensory and motor block, duration of analgesia, and complications that occur during the procedure.
This study was a prospective, comparative, randomized, and double-blind study.
Patients were randomly allocated to three groups of 30 each. Group I (n [number of patients] = 30) received bupivacaine 0.5% heavy 2.0 mL diluted up to 2.5 mL with normal saline. Group II ( = 30) received bupivacaine 0.5% heavy 2.0 mL and fentanyl 20 μg diluted up to 2.5 mL with normal saline, and Group III ( = 30) received bupivacaine 0.5% heavy 2.0 mL and fentanyl 50 μg diluted up to 2.5 mL with normal saline.
The data were analyzed using Chi-square and Student's -test.
The onset of sensory and motor block was early in Group III in comparison to Group I and Group II ( < 0.05). The duration of analgesia was significantly longer in Group III, followed by Group II, and least in Group I. None of the patients in Groups I and II had any complications such as hypotension, nausea, vomiting, bradycardia, and pruritus. However, the incidence of hypotension, nausea, and pruritus was more in Group III. 2 mg intrathecal bupivacaine with 20 μg fentanyl provides reliable and satisfactory sensory and motor block without increasing the incidence of side effects.
区域麻醉是大多数下腹部和下肢手术的首选技术，因为它能让患者保持清醒，并将与气道管理相关的问题降至最低。0.5%的重比重布比卡因虽然广泛用于脊髓麻醉，但存在作用时间短的局限性。添加芬太尼（一种合成的亲脂性阿片类药物）已知可延长术后镇痛时间。
我们旨在研究向重比重布比卡因中添加不同剂量芬太尼对血流动力学变化、感觉和运动阻滞程度、镇痛持续时间以及手术过程中发生的并发症的影响。
本研究是一项前瞻性、对比性、随机双盲研究。
患者被随机分为三组，每组30人。第一组（n[患者数量]=30）接受0.5%重比重布比卡因2.0 mL，用生理盐水稀释至2.5 mL。第二组（=30）接受0.5%重比重布比卡因2.0 mL和芬太尼20μg，用生理盐水稀释至2.5 mL，第三组（=30）接受0.5%重比重布比卡因2.0 mL和芬太尼50μg，用生理盐水稀释至2.5 mL。
数据采用卡方检验和学生t检验进行分析。
与第一组和第二组相比，第三组感觉和运动阻滞的起效时间更早（P<0.05）。第三组的镇痛持续时间明显更长，其次是第二组，第一组最短。第一组和第二组的患者均未出现低血压、恶心、呕吐、心动过缓和瘙痒等并发症。然而，第三组低血压、恶心和瘙痒的发生率更高。鞘内注射2 mg布比卡因加20μg芬太尼可提供可靠且令人满意的感觉和运动阻滞，而不增加副作用的发生率。
