Background: Various methods exist for treating post-operative pain which includes systemic narcotics, NSAIDS,
patient-controlled analgesia, regional anaesthesia techniques, epidural local anaesthetic – narcotic mixtures,
cryoanalgesia, transcutaneous electric nerve stimulation, psychological methods.
Various opioides intrathecally and epidurally have been tried for post-operative analgesia. These include - morphine,
pethidine, pentazocine, methadone, tramadol, Fentanyl, sufentanyl. In present study, we tried to find out analgesic
effectiveness of intrathecal Fentanyl for post-operative analgesia, combined with 0.5 % Bupivacaine and side effects if
any, in patients undergoing lower limb surgeries.
Materials and Methods: After approval from the local ethics committee and with written informed consent from
patient, a randomized controlled prospective study is carried out in the medical college and hospital.100 patients
belonging to American Society of Anesthesiologists (ASA)classification I & II, aged between 18-60 years, posted for
elective lower limb surgeries, were randomly allocated for the study.
Group-I: 50 patients received intrathecal 3 ml of 0.5 % hyperbaric Bupivacaine only.
Group-II : 50 patients received intrathecal 3 ml of 0.5% hyperbaric Bupivacaine and
Fentanyl 25 mcg.The patients studied across the group did not vary much with respect to age,height, weight and sex
distribution.
Results: The onset of sensory blockade was faster by 1.27 min in Group-BF. The perioperative and postoperative
hemodynamic parameters were comparable in both the groups. The sensory analgesia in Group II was significantly
prolonged by 159 mins, thus increasing the duration of analgesia. The time of first request of analgesics by the patients in
group-II is prolonged compared to group-I thus prolonging the duration of analgesia. Analgesic requirement is also
reduced in study group in early post-operative period. The onset of motor block was faster when Fentanyl was added to
intrathecal Bupivacaine and it was 1.1 min earlier in study group. The duration of motor block to Bromage III was
prolonged by almost 22 min in study group as compare to control group. Visual analogue scores were significantly lower
in group-II compared to group-I after two hours of surgery thus reducing the frequency of supplemental postoperative
analgesics.
Conclusion: With the present study we can summarize that intrathecal Fentanyl potentiates the action of Bupivacaine
thereby bringing about better quality and longer duration of analgesia, intense motor block, no hemodynamic
disturbance and better postoperative outcome with/ minimum side effects.