Premixed versus sequential administration of intrathecal fentanyl as a bupivacaine adjuvant in lower limb orthopedic surgeries: a prospective randomized controlled study

Authors

El Kenany S., Department of Anesthesia ,Surgical Intensive Care and Pain management, College of Medicine, Mansoura University, Mansoura, Egypt.

Article Type

Original Study

Abstract

Introduction: Intrathecal fentanyl is routinely mixed with hyperbaric bupivacaineduring spinal block, but this may alter the baricity of both drugs andhenceaffect their spread and action.Aim:This study aimed to compare the sequential administration of intrathecalfentanyl and bupivacaine to the routine mixing of the two drugs as regardthe block characteristics, the postoperative analgesia duration, and theadverseeffects.Methods:Current prospective, controlled, randomized trial was carried outon100 adult participants subjected to lower limb orthopedic surgeries underspinalanesthesia. Subjects were allocated randomly into two equal groups(50each). Group P: received premixed solution of hyperbaric bupivacaine(HB)0.5 % (12.5 mg) plus 25 µgof fentanyl in the same syringe and group < br />S:received 25 µgof fentanyl followed by 12.5 mg of HB in sequential manner.Block characteristics, time to the first rescue pethidine request, numberofparticipants who requested for pethidine within the first 6 postoperativehours,and adverse effects were assessed.Results:Group S patients had statistically significantly faster onset of bothsensory(4.58 ±1.5 vs 5. 40 ±1.8 min, p = 0.02) and motor block (5.79 ±1.5min versus 6.64 ±1.9 min, p = 0.01), shorter time to achieve the highestsensorylevel (6.12 ±1.96 min vs 8.77 ±2.5min, p = 0.00), and a longertimetill the first postoperative rescue analgesic need (252.26 ±39.3 minversus234.70 ±40.2 min, p = 0.03) . Group P patients achieved statisticallysignificantlyhigher level of sensory blockade and showed longer sensoryblockduration (216.30 ±30.8vs 199.44±23.8, p = 0.003). Adverse effectswerecomparable in both groups.Conclusions:The sequential administration of fentanyl and hyperbaric bupivacaineimproves the spinal block characters in patients subjected to lowerlimb orthopedic surgeries with comparable adverse effects profile in comparisonto mixing both drugs.

Recommended Citation

S., El Kenany (2016) "Premixed versus sequential administration of intrathecal fentanyl as a bupivacaine adjuvant in lower limb orthopedic surgeries: a prospective randomized controlled study," Mansoura Medical Journal: Vol. 46 : Iss. 1 , Article 2.
Available at: https://doi.org/10.21608/mjmu.2016.124256

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