The comparison of effectiveness of different doses of fentanyl added to hyperbaric bupivacaine for spinal anaesthesia in emergency appendectomy
The comparison of effectiveness of different doses of fentanyl added to hyperbaric bupivacaine for spinal anaesthesia in emergency appendectomy
Abstract
Introduction: General anesthesia is associated with greater risk from airway mishaps, gastric aspiration, and higher postoperative morbidity and mortality. Spinal anesthesia is similar to a nerve or plexus block method of eliminating pain sensation in a region of the body.
Objectives: To evaluate the effects of intrathecally administered fentanyl on the onset and duration of hyperbaric bupivacaine-induced sensory and motor spinal block and to determine the most suitable dose combination of fentanyl to local anesthesia.
Methodology: 120 patients who met the inclusion criteria were enrolled for the study and randomly divided into 4 groups after obtaining informed written consent. Group A (3ml of 0.5% hyperbaric bupivacaine + 0.6ml of normal saline), Group B (3ml of 0.5% hyperbaric bupivacaine + 10µg of fentanyl (0.2ml) + 0.4ml of normal saline), Group C (3ml of 0.5% hyperbaric bupivacaine + 20µg of fentanyl (0.4ml) + 0.2ml of normal saline) and Group D (3ml of 0.5% hyperbaric bupivacaine + 30µg of fentanyl (0.6ml)). The patients were then assessed for onset and duration of sensory block, side effects (nausea, vomiting, shivering) along with post-operative pain.
Results: There was no significant difference in ASA and nausea/vomiting except in shivering, rescue analgesia, and pain-free period. The duration of the pain-free period was longer in Group D. Group A had the highest incidence of Nausea/vomiting. The Group C (2.22±2.11hrs) patients required a longer duration for sensory regression of two dermatomes whereas Group A (1.49±0.01hrs) had a shorter duration for sensory regression of two dermatomes.
Conclusion: Addition of fentanyl 10µg, 20µg, and 30µg to bupivacaine in the spinal block for appendectomy provided excellent surgical anesthesia, prolonged the duration of spinal anesthesia with lesser incidences of side effects.
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