|
Comparative Evaluation of Intrathecal Minidose
Bupivacaine / Fentanyl vs. Conventional dose of Bupivacaine for
Surgical Repair of Inguinal Hernia in Elderly Patients
Walid Emara
Anaesthesia department, Faculty of Medicine, Tanta University
Tanta Med. Sc. J 2007; 2(3):19-29
Article type: Original article
Background/Aim: Spinal anesthesia is often used
for surgical repair of inguinal hernia in the geriatric population.
Intrathecal opioids enhance analgesia from subtherapeutic doses of
local anesthetic and make it possible to achieve successful spinal
anesthesia using otherwise inadequate doses of local anesthetic.
This study was designed to investigate and compare whether a
modification of the spinal anesthesia technique with addition of
opioid to the injectate, combined with a reduction in the amount of
bupivacaine versus conventional dose, could be effective procedure,
with stable haemodynamics, maintain postoperative pain relief and
reduce the recovery time, thus making spinal anesthesia more
suitable for ambulatory inguinal herniorrhaphy. Patients and
methods: Forty patients ASA physical status I-III were classified
into 2 equal groups. Group 1 received intrathecal bupivacaine 5 mg
plus fentanyl 20µg. Group2 received intrathecal bupivacaine 15 mg
only. Comparison of the 2 groups was in accordance to time of onset,
level of sensory blockade, duration of analgesia, mean arterial
blood pressure, heart rate, degree of pain sensation using visual
analogue scale, intraoperative and postoperative nausea and vomiting
, total amount of vasopressor used and time to recovery and home
discharge. Results: Our results showed that the time of onset of
maximal blockade was slightly faster in the minidose group patients
than the other group. The peak sensory level was higher in the
conventional dose group patients. The conventional dose group
patients were more likely to require treatment of hypotension than
patients in the minidose bupivacaine-fentanyl group. Total amount of
ephedrine requirements were in conventional dose group than the
minidose bupivacaine-fentanyl group. Recovery and home discharge
time was nonsignificantly prolonged in conventional dose group.
Conclusion: Minidose of 5 mg bupivacaine in combination with 20 µg
fentanyl provided spinal anesthesia for surgical repair of inguinal
hernia in the elderly. The minidose combination caused dramatically
less hypotension than 15 mg bupivacaine and nearly eliminated the
need for vasopressor support of blood pressure. |