UMA, SUREKHA, GANDHI, PRAVEEN : SA WITH LIGNOCAINE AND FENTANYL IndianADITYA, J. Anaesth. 2004; 48RAVINDRA, (2) : 121-123
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SPINAL ANAESTHESIA WITH LIGNOCAINE AND FENTANYL Dr. Uma Srivastava 1 Dr. Aditya Kumar 2 Dr. Surekha Saxena 3 Dr. Ravindra Saxena 4 Dr. N.K. Gandhi 5 Dr. Praveen Salar 6 SUMMARY In a prospective single blind study fifty healthy adult patients scheduled for elective surgery of inguinal herniorraphy were randomly assigned to receive spinal anaesthesia with 1.5 ml of 5% heavy lignocaine either with 25 g of fentanyl (group-F, n=25) or with 0.5 ml saline (group-N, n=25). The characteristics and duration of sensory and motor block, quality of intraoperative analgesia, time for first demand of analgesic in the postoperative period, time to pass urine and any adverse effects including occurrence of any neurologic symptoms were noted. The addition of fentanyl to spinal lignocaine speeded the onset time for sensory block, improved the intraoperative analgesia, and delayed the time of demand for analgesia without affecting motor blockade or time to pass urine. None of the patients in any group had transient neurological symptoms. Incidence of hypotension in the two groups was the same. Pruritis was more commonly seen in group-F. We concluded that 5% heavy lignocaine is safe for adult patients undergoing inguinal herniorrhaphy on inpatient basis. Addition of fentanyl is beneficial as it prolongs post-operative analgesia without affecting the recovery of spinal block.
Keywords : Spinal, Fentanyl, Lignocaine, and Transient neurological symptoms. Introduction Spinal anaesthesia with lignocaine heavy has been popular for short surgical procedures as it has predictable onset and provides dense sensory and motor block of moderate duration. The choice is based on a record of more than several decades of its safe use. Unfortunately, in the past decade some reports of neurotoxicity have cast doubts on the use of lignocaine for spinal anaesthesia.1,2,3 Consequently some authors warn against its use for spinal anaesthesia. The phenomenon of transient neurologic symptoms (TNS) may be associated with all local anaesthetics but it is 7-9 times higher following lignocaine than with bupivacaine.4 The etiology of TNS remains unclear and unproven5 as well as the reason why after nearly a century of use, it is only now being recognized as an adverse effect of spinal anaesthesia.6 In view of the controversy and uncertainity surrounding the use of spinal lignocaine the present study was undertaken. The aim of study was two fold, re-evaluation of the safety of spinal hyperbaric lignocaine regarding the occurrence of TNS and evaluation of any beneficial and adverse effects of addition of fentanyl to spinal lignocaine. 1,2,3,5. D.A., M.D., Assoc. Prof. 4. M.D., Senior Resident 6. M.B.B.S., Post Graduate Student Department of Anaesthesia, S.N. Medical College, Agra. Correspond to : Dr. Uma Srivastava 15, Master Plan Road, New Lajpat Kunj, Agra – 282002 E-mail :
[email protected] (Accepted for publication on 17-02-2004)
Methods After institutional ethical committee approval and consent 50 healthy adults of ASA grade I and II scheduled for elective surgeries of unilateral inguinal hernia repair were enrolled for the study. The subjects were randomly assigned to two groups. Group F patients received spinal anaesthesia with 1.5 ml of 5% lignocaine heavy along with fentanyl 25 g and group N (control group) received spinal anaesthesia with 1.5 ml of 5% heavy lignocaine with 0.5 ml of saline. All patients received oral tab. alprazolam 0.25 mg in the morning before operation. Prehydration was done with 500 ml of lactated Ringer’s solution. Lumbar puncture was performed in lateral position using 24 G spinal needle positioned midline at L3-4 interspace. Injection was given over 30 seconds after free flow of CSF was ensured. The patient was immediately turned to supine position. Onset and level of sensory block was noted using pinprick every two minutes until the level had stabilized. Onset and degree of motor block was noted using Bromage scale. The quality of anaesthesia during surgery was categorized as excellent – no pain or sensation and patient comfortable, good – patient had only the sensation of motion, fair - mild discomfort and required analgesia, poor – patient in agony and required supplementation by general anaesthesia. Blood pressure, pulse rate, ECG and SpO2 were monitored continuously. Any complication or adverse effects in the form of hypotension, bradycardia (fall of more than 20% of baseline value), nausea, vomiting, chest discomfort, pruritis, shivering and respiratory depression (fall in SpO2 below 90%) were noted and treated accordingly.
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After the operation, time of regression of sensory block, motor recovery and first demand of analgesia were recorded. All the patients were enquired on first and second post-operative day about the occurrence of headache, backache, paraesthesia, pain in thighs, buttocks or legs etc. For statistical analysis, Student ‘t’ test was used for comparison between the groups and one way analysis of variance (ANOVA) was used for haemodynamic parameters in the same group. Results Table-1 shows the baseline characteristics of the groups. There was no significant difference in patient’s age, sex, weight, type or duration of operation among the groups. The onset and time to reach highest level of sensory level was significantly less in group F (p0.05). Table - 1 : Patients characteristics (Mean±SD) Group – F
Group – N
39.08±11.99
35.31±12.21
21/4
20/5
Weight (kg)
51.24±11.46
52.26±11.46
Height (ft)
5.4±3.00
5.3±3.00
59.62±13.04
58.42±12.84
Age Sex (M/F)
Duration of operation (min)
Table - 2 : Study results (Mean±SD) Group – F
Group – N
Stat. significance
Sensory block – Onset time (mins)
3.68±1.99
5.49±2.13
