Research & Innovation in Anesthesia

Register      Login

VOLUME 3 , ISSUE 1 ( 2018 ) > List of Articles


Low-dose Bupivacaine with Fentanyl for Spinal Anesthesia during Ambulatory Inguinal Hernia Repair Surgery: A Comparison between 7.5 and 10 mg of 0.5% Hyperbaric Bupivacaine—A Retrospective Study

Sweta Salgaonkar, Bharati A Tendolkar, Shrikanta P Oak, Divya Darshni

Keywords : Ambulatory surgery, Inguinal hernia repair, Lowdose bupivacaine.

Citation Information : Salgaonkar S, Tendolkar BA, Oak SP, Darshni D. Low-dose Bupivacaine with Fentanyl for Spinal Anesthesia during Ambulatory Inguinal Hernia Repair Surgery: A Comparison between 7.5 and 10 mg of 0.5% Hyperbaric Bupivacaine—A Retrospective Study. Res Inno Anesth 2018; 3 (1):8-12.

DOI: 10.5005/jp-journals-10049-0040

License: CC BY-SA 4.0

Published Online: 01-03-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Ambulatory anesthesia aims at early discharge with minimal side effects. The study aimed to establish the efficacy of 7.5 vs 10 mg of hyperbaric bupivacaine (bupivacaine H) for spinal anesthesia (SA) for inguinal hernia repair in terms of onset of block, maximum surgical level achieved, motor block, hemodynamic parameters, recovery profile, and complication rate. Materials and methods: Anesthesia records of 200 male patients who underwent inguinal hernia repair under SA were studied. About 100 patients who received SA with 1.5 mL of 0.5% bupivacaine H + 25 μg fentanyl + 1 mL normal saline (NS) were labeled group L and 100 patients who received 2 mL of 0.5% bupivacaine H + 25 μg fentanyl + 0.5 mL NS were labeled group H. All patients were given SA using 25G Quincke's needle at L3/4 or L4/5 level. Sensory level was assessed with pinprick and motor blockade using modified Bromage scale (MBS). Hemodynamic parameters, sensory level, and motor blockade were noted every 5 minutes for first 15 minutes and every 15 minutes till the complete recovery of motor blockade. Analgesic requirement and rate of conversion to general anesthesia (GA) were noted. Results: The time for onset of action in group L vs group H was 4.7 ± 1.57 minutes vs 4.46 ± 0.95 minutes, which was not significant. However, the two segment regression time was 71.84 ± 8.02 minutes vs 93.70 ± 6.60 minutes in groups L vs H (p-value < 0.05), time to return to S1 was 158.5 ± 13.8 minutes vs 196 ± 31.68 minutes (p-value < 0.05), time to ambulation was 182 ± 15.80 minutes vs 304 ± 47.88 minutes (p-value 0.05), time to void was 198.37 ± 18.15 minutes vs 325.4 ± 53.73 minutes (p-value < 0.05), and time to home readiness was 293.4 ± 29.39 minutes vs 440.20 ± 37.93 minutes (p-value < 0.5). The rate of complications was comparable in both groups and the rate of conversion to GA was nil. Group L had superior hemodynamic stability. Conclusion: About 7.5 mg of 0.5% bupivacaine H with fentanyl offers excellent anesthesia for inguinal hernia repair in terms of adequate anesthesia, better hemodynamic stability, reduced complications, and early discharge vs 10 mg of bupivacaine H with fentanyl; hence it is ideal for ambulatory surgery.

PDF Share
  1. Gupta A, Axelsson K, Thörn SE, Matthiessen P, Larsson LG, Holmström B, Wattwil M. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7.5 mg of bupivacaine. Acta Anaesthesiol Scand 2003 Jan;47(1):13-19.
  2. Unal D, Ozdogan L, Ornek HD, Sonmez HK, Ayderen T, Arslan M, Dikmen B. Selective spinal anaesthesia with lowdose bupivacaine and bupivacaine+ fentanyl in ambulatory arthroscopic knee surgery. J Pak Med Assoc 2012 Apr;62(4): 313-318.
  3. Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiology 1993 Oct;79(4):766-773.
  4. Penning JP, Yaksh TL. Interaction of intrathecal morphine with bupivacaine and lidocaine in the rat. Anesthesiology 1992 Dec;77(6):1186-2000.
  5. Urmey WF. Spinal anaesthesia for outpatient surgery. Best Pract Res Clin Anaesthesiol 2003 Sep;17(3):335-346.
  6. Leslie K, Sessler DI. Reduction in the shivering threshold is proportional to spinal block height. Anesthesiology 1996 Jun;84(6):1327-1331.
  7. Stienstra R, Veering BT. Intrathecal drug spread: is it controllable? Reg Anesth Pain Med 1998 Jul-Aug;23(4):347-351.
  8. Pitkänen M, Rosenberg PH. Local anaesthetics and additives for spinal anaesthesia—characteristics and factors influencing the spread and duration of the block. Best Pract Res Clin Anaesthesiol 2003 Sep;17(3):305-322.
  9. Greene NM. Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg 1985 Jul;64(7):715-730.
  10. Ben-David B, Levin H, Solomon E, Admoni H, Vaida S. Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 1996 Oct;83(4):716-720.
  11. Iannuzzi E, Iannuzzi M, Viola G, Chiefari M. Spinal anaesthesia using hyperbaric 0.75% vs hyperbaric 1% bupivacaine: a double blind comparison. Minerva Anestesiol 2004 Mar;70(3):91-96.
  12. Runza M, Albani A, Tagliabue M, Haiek M, LoPresti S, Birnbach DJ. Spinal anesthesia using hyperbaric 0.75% versus hyperbaric 1% bupivacaine for cesarean section. Anesth Analg 1998 Nov;87(5):1099-1103.
  13. Gallo F, Alberti A, Fongaro A, Negri MG, Carlot A, Altafini L, Valenti S. Spinal anesthesia in cesarean section: 1% versus 0.5% hyperbaric bupivacaine. Minerva Anestesiol 1996 Jan-Feb; 62(1-2):9-15.
  14. Mulroy MF, Wills RP. Spinal anesthesia for outpatients: appropriate agents and techniques. J Clin Anesth 1995 Nov; 7(7):622-627.
  15. Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997 Sep;85(3):560-565.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.