A COMPARATIVE STUDY OF INTRATHECAL FENTANYL AND BUPRINORPHINE AS ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE IN SPINAL ANAESTHESIA FOR LOWER ABDOMINAL AND LOWER LIMB SURGERY.

Abstract

Background: Intrathecal opioids as adjuvant to local anesthetics, act synergistically to
overcome the shortcomings of reduced duration and postoperative analgesia. Short acting
opioid like fentanyl enhance the sensory blockade of local anesthetics without affecting the
sympathetic activity. Buprenorphine a mu receptor partial agonist, administered intrathecally
with bupivacaine improved the quality and duration of postoperative analgesia. This study was
conducted to evaluate and compare the characteristics of spinal block and its side effects in
patients undergoing lower abdominal surgeries using intrathecal bupivacaine and its
combination with fentanylor buprenorphine.
Methods: In our Prospective Interventional study (March 2021- August 2021), 60 patients
aged between 18-70 years of ASA 1 and 2 undergoing lower abdominal surgeries were
included, after ethical clearance. Two groups of 30 each were randomly allocated by computer
generated random number table, Group A received 3ml of intrathecal hyperbaric bupivacaine
with 0.5mcg\KG of fentanyl and group B received 3ml of intrathecal hyperbaric bupivacaine
with 2mcg\kg of buprenorphine. Onset and regression of sensory and motor blockade, duration of analgesiawas noted in both the groups. Sedation scores and side effects were evaluated. Statistical analysis was by Student’s t-test and Chi-square test.
Results: The mean time of onset of sensory, motor blockade and the time to achievemaximum
sensory level and sedation scores was comparable in both the groups (p> 0.005). Duration of
motor blockade and analgesia, two segment regression time was significantly prolonged in
Group B compared to Group F (p<0.001). Side effectsnoted were pruritis, nausea and vomiting
in both the groups.
Conclusion:
Intrathecal Buprenorphine (60mcg) in combination with bupivacaine provides comparable
onset of sensory and motor blockade but longer total duration of motor blockade and analgesia as with intrathecal fentanyl (25mcg).