Saxena Lipika, Bharadwaj Avnish, Verma Kalpana, Mongia Pooja, Lunia Gautam
Anesthesiology, Mahatma Gandhi Medical College and Research Institute, Jaipur, IND.
Community Medicine, Sarder Patel Medical College, Bikaner, IND.
Cureus. 2024 Jul 2;16(7):e63666. doi: 10.7759/cureus.63666. eCollection 2024 Jul.
Background Adjuvants are often used during subarachnoid block to enhance and prolong the analgesia and decrease the adverse effects of high doses of local anesthetic agents. Intrathecal fentanyl premixed with hyperbaric bupivacaine has been used in spinal anesthesia and compared with the sequential use of these drugs in separate syringes. However, given the paucity of literature, we conducted this study where premixed antecedent and succedent administration of intrathecal fentanyl with hyperbaric bupivacaine were compared in terms of flow dynamics, block characteristics, and hemodynamic alterations. Methodology This prospective, randomized, triple-blinded comparative study was conducted among 160 patients who were randomly allocated into four groups. Group A (n = 40) (control) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL of normal saline via a 5.0 mL syringe. Group B (n = 40) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 µg) of fentanyl premixed via a single 5.0 mL syringe. Group C (n = 40) received 0.5 mL (25 µg) of fentanyl via a 1.0 mL syringe followed by 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine via a 5.0 mL syringe. Group D (n = 40) received 3.0 mL (15 mg) of 0.5% hyperbaric bupivacaine via a 5.0 mL syringe followed by 0.5 mL (25 µg) of fentanyl via a 1.0 mL syringe. The onset and regression of sensory and motor blockade, hemodynamic parameters, time to first rescue analgesia, and adverse events were observed. Data analysis was done using SPSS version 17.0 (SPSS Statistics Inc., Chicago, IL, USA). Results The mean time taken for the onset of sensory and motor blockade was least in Group D followed by Group C. Duration of sensory and motor blockade was prolonged in Group D. Patients in Group A experienced more hypotension than Groups B, C, and D. Requirement of rescue analgesia was delayed in Groups C and D. Conclusions Administering 25 µg (0.5 mL) of Fentanyl separately after 15 mg (3.0 mL) of 0.5% hyperbaric bupivacaine results in early onset and prolonged duration of sensory and motor blockade, intraoperative hemodynamic stability, the delayed requirement of rescue analgesia postoperatively, and fewer side effects compared to its co-administration as a premixed solution or antecedent to hyperbaric bupivacaine.
蛛网膜下腔阻滞期间常使用佐剂来增强和延长镇痛效果，并减少高剂量局部麻醉药的不良反应。鞘内注射与重比重布比卡因预混的芬太尼已用于脊髓麻醉，并与在单独注射器中序贯使用这些药物进行了比较。然而，鉴于文献资料匮乏，我们开展了本研究，比较鞘内注射芬太尼与重比重布比卡因预混前后给药在血流动力学、阻滞特征和血流动力学改变方面的差异。
本前瞻性、随机、三盲对照研究纳入了160例患者，他们被随机分为四组。A组（n = 40）（对照组）通过一个5.0 mL注射器接受3.0 mL（15 mg）0.5%重比重布比卡因和0.5 mL生理盐水。B组（n = 40）通过一个5.0 mL注射器接受3.0 mL（15 mg）0.5%重比重布比卡因和0.5 mL（25 μg）预混的芬太尼。C组（n = 40）通过一个1.0 mL注射器接受0.5 mL（25 μg）芬太尼，随后通过一个5.0 mL注射器接受3.0 mL（15 mg）0.5%重比重布比卡因。D组（n = 40）通过一个5.0 mL注射器接受3.0 mL（15 mg）0.5%重比重布比卡因，随后通过一个1.0 mL注射器接受0.5 mL（25 μg）芬太尼。观察感觉和运动阻滞的起效和消退、血流动力学参数、首次补救镇痛时间及不良事件。使用SPSS 17.0版软件（美国伊利诺伊州芝加哥市SPSS统计公司）进行数据分析。
感觉和运动阻滞起效的平均时间在D组最短，其次是C组。D组感觉和运动阻滞的持续时间延长。A组患者发生低血压的情况比B、C、D组更多。C组和D组补救镇痛的需求延迟。
与作为预混溶液或在重比重布比卡因之前联合给药相比，在15 mg（3.0 mL）0.5%重比重布比卡因之后单独给予25 μg（0.5 mL）芬太尼可使感觉和运动阻滞起效早、持续时间延长，术中血流动力学稳定，术后补救镇痛需求延迟，且副作用更少。
