COMPARISON OF BUPIVACAINE AND BUPIVACAINE WITH FENTANYL IN LOWER LIMB ORTHOPAEDIC SURGERIES
INTRODUCTION: A commonly used technique for lower limb surgeries is subarachnoid blockade. If there is inadequate control of pain, will affect quality, and functional recovery, also there is chance of postsurgical complications, and the risk of persistent postsurgical pain. Use of epidural analgesic technique for lower limb surgeries should provide better pain relief with minimal side effects, leading to improved outcome. Bupivacaine hydrochloride is a local anaesthetic drug, which was used clinically in 1963. Bupivacaine acts mainly by blockade of voltage-gated Na+ channels in the axonal membrane and possibly has a further effect on presynaptic inhibition of calcium channels. Fentanyl is a powerful synthetic opioid which is similar to morphine but is 50 - 100 times more potent, which is used to treat patients with severe pain, especially after surgeries.
MATERIAL AND METHODS: This prospective randomized study was conducted in the department of anaesthesiology at Rajiv Gandhi Institute of Medical Science, Adilabad, to compare single shot epidural 8ml 0.5 % bupivacaine alone verses 8ml 0.5% bupivacaine along with 0.50 mcg Fentanyl. Total of 80 patients with ASA(American society of anaesthesiologists) I and II with age group between 24 to 56 years were included and 40 patients each were randomly placed in bupivacaine alone group (Group 1) and fentanyl in combination with bupivacaine group (Group 2). Written informed consent from all the patients was obtained.
RESULTS: Mean (SD) systolic blood pressure was observed to be 128.45(12.47) and 130.25(11.55) in group 1 and group 2 respectively. Mean time for T 10 sensory block was significantly earlier in group 2 12.03(1.12) compared to group 1 18.24(2.54). Onset of motor block was observed to differ significantly, where onset was significantly earlier in group 2 23.17(1.77) in comparison to group 1 28.45(1.49). The first analgesic requirement in Group 1 was earlier at 198.20 + 11.49 min as compared to Group 2 at 279.34 + 18.42 min.
CONCLUSION: Bupivacaine with Fentanyl enhances the onset of action and duration of effect for two segment regression. In present study the time to achieve T10 sensory block was early in Group 2 12.03(1.12) compared to group1 18.24(2.54).Onset of group2 23.17(1.77) in comparison to group1 28.45(1.49). Time of first analgesic requirement was found to be earlier at 279.34 + 18.42 minutes in group2 in comparison to group1 198.20 + 11.49 minutes.