Intrathecal Fentanyl with Small-Dose Bupivacaine: Stable Hemodynamics in Geriatric Population Undergoing Orthopedic Surgery

Intrathecal Fentanyl with Small-Dose Bupivacaine

Authors

  • Azmat Ali Shah Armed Forces Hospital Najran, Saudi Arabia
  • Mujahid Ul Islam Rehman Medical Institute, Peshawar
  • Imtiaz Ahmad Rehman Medical Institute, Peshawar
  • Ansa Islam Ayub Medical College, Abbattobad
  • Syed Ahsan Shabir Gillani Rehman Medical Institute, Peshawar
  • Muhammad Anwar Farooq Rehman Medical Institute, Peshawar
  • Muhammad Shahid Rehman Medical Institute, Peshawar
  • Faizan Ahmad Ali Rehman Medical Institute, Peshawar

DOI:

https://doi.org/10.54393/pbmj.v5i4.381

Keywords:

local anesthetic, Intrathecal Fentanyl, Small-Dose Bupivacaine, Geriatric Population, Undergoing Orthopedic Surgery

Abstract

Fentanyl (FNL) has been used since long for the management of intense pain due to cancerous and non-cancerous diseases. Bupivacaine (BVP) is also a widely used local anesthetic used in surgery and obstetrics. Objective: To examine the clinical effect of small-dose (20 mcg) fentanyl added to spinal anesthesia with small-dose dilute bupivacaine (6 mg of 0.7% bupivacaine) on anesthesia quality and recovery. Methods: This study was conducted in Ayub Teaching Hospital after taking the ethical approval from hospital review board. Informed consent was obtained from all patients. Patients accepted for the study were all ASA I or II physical status presenting for ambulatory arthroscopic surgery of the knee. Sample size of 60 were determined by power analysis based on standard deviation data from our previously published report, P % 0.05, and the assumption of a 90% power to detect a 30-min difference in mean time to complete sensory recovery. Results: Total 60 patients were enrolled in current study. The mean age of patients was 78.52+8.22. There were 47(78.3%) male and 13(21.7%) were female. The hemodynamic changes from start of the procedure after 30 minutes were noted. The mean systolic blood pressure at base line was 120.65+18.197 and at 30 minutes was 118.98+14.39. The mean diastolic blood pressure at base line was 74.83+16.569 and at 30 minutes was 73.70+13.41. The mean heart rate at base line was 62.73+5.90 and at 30 minutes was 62.61+5.87. The mean heart rate at base line was 89.72+16.728 and at 30 minutes was 88.38+13.26. Conclusion: Intrathecal fentanyl with reduced dose bupivacaine in elderly patients undergoing orthopedic surgery maintains hemodynamic stability

References

Olawin AM, M Das J. Spinal Anesthesia. [Updated 2021 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537299/

Bi YH, Cui XG, Zhang RQ, Song CY, Zhang YZ. Low dose of dexmedetomidine as an adjuvant to bupivacaine in cesarean surgery provides better intraoperative somato-visceral sensory block characteristics and postoperative analgesia. Oncotarget. 2017;8(38):63587–63595. doi:10.18632/oncotarget.18864

Stanley TH. The fentanyl story. J Pain. 2014 Dec;15(12):1215-26. doi: 10.1016/j.jpain.2014.08.010.

Limratana P, Kiatchai T, Somnuke P, Prapakorn P, Suksompong S. The effect of baricity of intrathecal bupivacaine for elective cesarean delivery on maternal cardiac output: a randomized study. Int J Obstet Anesth. 2021 Feb;45:61-66. doi: 10.1016/j.ijoa.2020.07.011.

Gristwood RW. Cardiac and CNS toxicity of levobupivacaine strength of evidence for advantage over bupivacaine: strength of evidence for advantage over bupivacaine. Drug Safety. 2002;25(3):153–163. doi: 10.2165/00002018-200225030-00002.

Juelsgaard P, Sand NP, Felsby S, Dalsgaard J, Jakobsen KB, Brink O, Carlsson PS, Thygesen K. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol. 1998 Nov;15(6):656-63. doi: 10.1097/00003643-199811000-00006.

Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology. 2000,92(1):6-10. doi: 10.1097/00000542-200001000-00007.

Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology. 1996 ,84(6):1361-7. doi: 10.1097/00000542-199606000-00012.

Tejwani GA, Rattan AK, McDonald JS. Role of spinal opioid receptors in the antinociceptive interactions between intrathecal morphine and bupivacaine. Anesth Analg. 1992,74(5):726-34. doi: 10.1213/00000539-199205000-00018.

Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology. 1992,77(6):1186-2000. doi: 10.1097/00000542-199212000-00021.

Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoïpé M, Lassié P, et al. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg. 1996,82(2):312-6. doi: 10.1097/00000539-199602000-00017.

Chan VW, Chung F, Gomez M, Seyone C, Baylon G. Anesthetic and hemodynamic effects of single bolus versus incremental titration of hyperbaric spinal lidocaine through microcatheter. Anesth Analg. 1994,79(1):117-23. doi: 10.1213/00000539-199407000-00022.

Valentin N, Lomholt B, Jensen JS, Hejgaard N, Kreiner S. Spinal or general anaesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth. 1986,58(3):284-91. doi: 10.1093/bja/58.3.284.

Casati A, Aldegheri G, Vinciguerra E, Marsan A, Fraschini G, et al. Randomized comparison between sevoflurane anaesthesia and unilateral spinal anaesthesia in elderly patients undergoing orthopaedic surgery. Eur J Anaesthesiol. 2003,20(8):640-6. doi: 10.1017/s0265021503001030.

Pitkänen M, Haapaniemi L, Tuominen M, Rosenberg PH. Influence of age on spinal anaesthesia with isobaric 0.5% bupivacaine. Br J Anaesth. 1984,56(3):279-84. doi: 10.1093/bja/56.3.279.

Covert CR, Fox GS. Anaesthesia for hip surgery in the elderly. Can J Anaesth. 1989,36(3 Pt 1):311-9. doi: 10.1007/BF03010771.

Nightingale PJ, Marstrand T. Subarachnoid anaesthesia with bupivacaine for orthopaedic procedures in the elderly. Br J Anaesth. 1981,53(4):369-71. doi: 10.1093/bja/53.4.369.

Djokovic JL, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA. 1979,242(21):2301-6.

Herminghaus A, Wachowiak M, Wilhelm W, Gottschalk A, Eggert K, Gottschalk A. Intravenös verabreichtes Lidocain zur perioperativen Schmerztherapie. Übersicht und praktische Handlungsempfehlungen [Intravenous administration of lidocaine for perioperative analgesia. Review and recommendations for practical usage]. Anaesthesist. 2011 Feb;60(2):152-60. German. doi: 10.1007/s00101-010-1829-0.

del-Rio-Vellosillo M, Garcia-Medina JJ, Abengochea-Cotaina A, Pinazo-Duran MD, Barbera-Alacreu M. Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. Biomed Res Int. 2014;2014:349034. doi: 10.1155/2014/349034.

Downloads

Published

2022-04-30

How to Cite

Shah , A. A. ., Islam, M. U. ., Ahmad , I., Islam , A. ., Gillani , S. A. S. ., Farooq , M. A. ., Shahid , M. ., & Ali , F. A. (2022). Intrathecal Fentanyl with Small-Dose Bupivacaine: Stable Hemodynamics in Geriatric Population Undergoing Orthopedic Surgery: Intrathecal Fentanyl with Small-Dose Bupivacaine. Pakistan BioMedical Journal, 5(4), 239–243. https://doi.org/10.54393/pbmj.v5i4.381

Issue

Section

Original Article