A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL HYPERBARIC BUPIVACAINE WITH BUPRENORPHINE AND HYPERBARIC BUPIVACAINE WITH FENTANYL IN SPINAL ANAESTHESIA FOR LOWER ABDOMINAL AND LOWER LIMB SURGERIES

Dr. Deba Gopal Pathak, Dr. Peter Engti

Abstract


BACKGROUND: Spinal anaesthesia is the most commonly used technique for lower abdominal, lower limb surgeries. In clinical practice both Fentanyl and buprenorphine have been used as adjuvants with bupivacaine for spinal anesthesia. So, this present study has been conducted to assess the better drug between these two adjuvants with regard to post-operative analgesia and haemodynamic stability.

OBJECTIVE: To study the effects of 0.5% hyperbaric bupivacaine with buprenorphine and 0.5% hyperbaric bupivacaine with fentanyl in spinal anaesthesia for lower abdominal and lower limb surgeries.

SETTINGS & DESIGN: This comparative study included 50 patients in two groups, of ASA class I & II undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written informed consent of patients.

MATERIALS AND METHODS: Patients were categorized into two groups (n=50) A & B. Group A received 75μg of buprenorphine and Group B received 25μg of fentanyl as adjuvants to 15mg of 0.5% hyperbaric bupivacaine (3.0ml). Onset of sensory block and motor block, two segment regression, time of sensory and motor block, duration of sensory & motor block, duration of analgesia, haemodynamic changes and side effects were recorded.

RESULTS: There was no significant difference in onset of sensory block in two groups (P>0.05), but onset of motor block was significantly earlier in buprenorphine group. Two segment regression time, duration of sensory & motor block, duration of analgesia were significantly longer for group A as compared to group B (P< 0.05).

CONCLUSION: The duration of sensory block, motor block and duration of post-operative analgesia was better in buprenorphine group in comparison to fentanyl group. Both the drugs prolong the duration of analgesia on giving intrathecally along with bupivacaine heavy. These drugs can be used to prolong duration of analgesia in lower abdominal and lower limb surgeries without having any significant side effect.


Keywords


Spinal anaesthesia, Intrathecal hyperbaric bupivacaine, Buprenorphine, Fentanyl.

Full Text:

PDF

References


John J. B. 1985. History of Pain concepts and Pain therapy. Seminars in Anesthesia. 4: 189-207

Yaksh T. L. & Rudy, T. A. 1976. Analgesia mediated by a direct spinal action of narcotics. Science. 192: 1357-1358.

Harmer M, Slattery P. J, Ronsen M. & Vickers M. N. 1983. Comparison between buprenorphine and pentazocine given IV on demand in control of post operative pain. Br J Anaesth. 55: 21-25

Pert C. B. & Snyder, S.1973. Opiate Receptors: Demonstration in Nervous Tissue. Scienc. 179:101

Seewal R, Shende D, Kashyap L. & Mohan, V. 2007. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: a dose-response study. RegAnesth Pain Med. 32 (1): 20-6.

Hunt C. O, Naulty J. S., Bader A. M, et al. 1989. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology. 71: 535–540.

Howell B. C. & Ward A. E. 1977 Pain relief in the postoperative period: a comparative trial of morphine and a new analgesic buprenorphine. J Int Med Res.5:417-421.

Kay B. A. 1978. Double blind comparison of morphine and buprenorphine in the prevention of pain after operation. Br J Anaesth.50:605-608.

Lanz E, Suke, G, Theiss D & Glocke M. H.1984. Epidural buprenorphine- a double blind study of postoperative analgesia and side effects. AnesthAnalg. 63: 593-598.

Capogna G & Celleno D. Spinal buprenorphine for postoperative analgesia after caesarean section. Acta Anaesthesiol Scand.1989; 33:236-238.

Reuben SS, Dunn SM, Duprat KM, O’Sullivan P. An intrathecal fentanyl dose-response study in lower extremity revascularization procedures. Anaesthesiology.1994; 81(6): 1371-5.

Pal R, Arora, K. K. & Doneria N. S. 2015. Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants to 0.5% Hyperbaric Bupivacaine in Lower Abdominal and Lower Limb Surgeries: A Prospective, Randomized and Comparative Study. Journal of Evolution of Medical and Dental Sciences. 4 (46): 8009-8017.

Bhukya N, Madhavi, Kalyanam P. et al. 2017. Comparative study between intrathecal bupivacaine 0.5% heavy + fentanyl (0.5 micrograms/kg) versus intrathecal bupivacaine 0.5% heavy + buprenorphine (2 micrograms/kg) in lower abdominal and lower limb surgeries. J. Evid. Based Med. Healthc. 4(84):4958-4967.

Krishnakumar , Chandrasekaran A, & Nanthaprabu M. 2016. Intrathecal Buprenorphine, Clonidine and Fentanyl as Adjuvants To 0.5% Hyperbaric Bupivacaine In Lower Abdominal Surgeries: A Prospective, Randomized And Comparative Study. IOSR-JDMS. 15 (7): 25-30.

Khan F. A. & Hamdani G. A. 2006. Comparison of intrathecal fentanyl and buprenorphine in urological surgery. J Pak Med Assoc. 56(6):277-81.

Kamal S & Davies C. V. 2017. A prospective randomised double blind study of the comparison of two opioids- fentanyl and buprenorphine – as adjuvant to spinal bupivacaine in caesarean sections. International Journal of Clinical Trials. 4 (1): 45-48.

Bogra J, Arora N. & Srivastava P. 2005. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiology. 5(1). doi:10.1186/1471-2253-5-5.

Singh H, Yang J, Thornton K. & Giesecke A. H. 1995. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Canadian Journal of Anaesthesia. 42 (11): 987–991.

Acharya B, Acharya K. P, Sigdel S. & Marhatta M. N. 2019. Effect of Low Dose Bupivacaine and Fentanyl during Elective Cesarean Section under Spinal Anesthesia. J Anesth Clin Res 10: 892.

Kaur R, Singh AP, Gupta R, Kumari A. Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries. J Anaesthesiol Clin Pharmacol. 2016;32:229-33.

Borse Y. M, Thorat S. A, Dighe J. P. & Patil P. J. 2015. A Comparative Study OfIntrathecal Bupivacaine And Bupivacaine With Buprenorphine For Post-Operative Analgesia In Orthopedic Surgeries. Indian Journal of Clinical Anaesthesia. 2 (2): 92-96.

Nelamangala K, Madhusudhana R, Krishnamurthy D, Seshu N. & Vasantha K. (2016). Comparative Study of Intrathecal Bupivacaine with Additives Buphrenorphine and Fentanyl for Post Operative Analgesia. 15. 39-42.

Dixit S. 2007. Post-operative analgesia after caesarean section: an experience with intrathecal buprenorphine. Indian J Anaesth. 51:515-8.

Gupta M, Shailaja S. & Hegde K. S. 2014. Comparison of intrathecal dexmedetomidine with buprenorphine as adjuvant to bupivacaine in spinal anaesthesia. J ClinDiagn Res. 8(2):114–117.


Refbacks

  • There are currently no refbacks.