Abstract
Background: Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anaesthesia. The aim of this study is to compare the effects of adding fentanyl to low dose bupivacaine in spinal anesthesia for Transurethral Resection of Prostate (TURP).
Methods: In this prospective, randomized double-blind study, spinal anaesthesia was performed in 50 American Society of Anesthesiologists I-III patients aged 55-90 years old, undergoing Transurethral Resection of Prostate using 10mg hyperbaric bupivacaine 0.5%- 2 ml (Group A) or by adding fentanyl 25 μg (Group B) to 9 mg hyperbaric bupivacaine 0.5%-2 ml (Group B). These groups were compared in terms of the quality of spinal anaesthesia as well as analgesia. The primary outcome was time to 2 segment regression and corresponding motor block. Secondary outcomes were time to reach maximal upper sensory level, maximal level of sensory block, and corresponding degree of motor block. Haemodynamic variables were also assessed.
Results: The onset of motor blockade was significantly rapid in Group II as compared with Group I. Quality of analgesia was significantly better and prolonged in fentanyl group as compared with low– dose bupivacaine alone group (P= 0.000). The maximum upper level of sensory block was higher in Group II patients than Group I patients. (P = 0.023). Motor block was more intense and more prolonged in fentanyl group as compared with Group I patients. The median (minimum, maximum) time to attain maximum level of upper sensory block was 5 (2,10) and 4 (2, 6) minutes for low – dose bupivacaine and for low – dose bupivacaine with fentanyl respectively. Mean maximal level was T6-T7 and T5-T6 for low – dose bupivacaine and for low – dose bupivacaine with fentanyl respectively. Duration of block above T10 was 44 (30, 60) and 63 (30,80) minutes for Group I and Group II respectively (P=0.000).
Conclusions: Spinal anaesthesia in elderly patients using low dose bupivacaine (10 mg) combined with 25 μg fentanyl is associated with a lower incidence of haemodynamic instability, better quality and prolonged duration.
Keywords: Low- Dose Bupivacaine, Fentanyl, Transurethral Resection of Prostate.
References
- Hong JY, Yang SC, Ahn S, Kil HK. Preoperative comorbidities and relationship of comorbidities with postoperative complications in patients undergoing transurethral prostate resection .Journal of Urology.185, 1374-1378 (2011).
- Kim SY,CHO JE, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy British Journal of Anaesthesia; 103, 750–754 (2009).
- Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery.Anesthesia Analgesia 85, 560–565 (1997).
- Shesky MC, Rocco AG, Bizzarri-Schmid M, Francis DM, Edstrom H, Covino BG. A dose-response study of bupivacaine for spinal anesthesia. Anesthesia Analgesia 62, 931–935 (1983).
- Ruppen W, Steiner LA, Drewe J, Hauenstein L, Brugger S, Seeberger MD. Bupivacaine concentrations in the lumbar cerebrospinal fluid of patients during spinal anaesthesia. British Journal of Anaesthesia. 102, 832–838 (2009)
- Veering BT, Immink-Speet TTM, Burm AGL, Stienstra R, van Kleeef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position. British Journal of Anaesthesia, 87, 738–742 (2001).
- Akcoboy EY, Akcaboy ZN, Gogus N. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. J. Res. Med. Sci., 16, 68–73 (2011).
- 8)Erdil F, Bulut S, DerDemirbilek S, Gedik E, Gulhas N, Ersoy MO. The effects of intrathecal levobupivacaine and bupivacaine in the elderly. Anaesthesia, 64, 942–946 (2009).
- Kuusniemi KS, Pihlajamaki KK, Pitkanen MT, Helenius HY, Kirvela OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesthesia Analgesia91, 1452–1456 (2000).
- De Kock M, Gautier P, Fanard L, Hody JL, Lavand’homme P. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology, 94, 574–578 (2001).
- Mohamed AA, Fares KM, Mohamed SA. Efficacy of intrathecally administered dexmedetomidineversus dexmedetom-idine with fentanyl in patients undergoing major abdominal cancer surgery. Pain Physician, 15, 339–348 (2012).
- Al-Ghanem SM, Massad IM, Al-Mustafa MM, Al-Zaben KR, Qudaisat IY, Qatawneh AM, Abu-Ali HM. Effect of adding dexmedetomidineversus fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures: A double blind controlled study. American Journal of Applied Sciences,6, 882–887 (2009).
- Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. 1998;88:355–61.
- Nelson KE, Rauch T, Terebuh V, D’ Angelo R. A comparison of intrathecal fentanyl and sufentanil for labor ana-lgesia. 2002;96:1070–3.
- Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. Journal of Anaesthesiology Clinical Pharmacology, 27, 339–343 (2011).
- KararmazA, Kaya S, Turhanoglu S, Ozyilmaz MA. Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. 2003;58:526–30.
- Soni AK, Miller CG, Pratt SD, Hess PE, Oriol NE, Sarna MC. Low dose intrathecal ropivacaine with or without sufentanil provides effective analgesia and does not impair motor strength during labor: A pilot study.Canadian Journal of Anaesthesia. 2001;48:677–80.
- Lee YY , Ngan Kee WD, Muchhal K, Chan CK. Randomized double blind comparison of Ropivacaine Fentanyl and Bupivacaine Fentanyl for spinal anaesthesia for urological surgery. Acta Anaesthesiol Scand 2005; 49: 1477-82.
Corresponding Author
Sheeba Franklin
Njondimackal, Thellakom.P.O, Kottayam
Telephone no; 0481-2791655, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.129
