Clinical evaluation and comparison of analgesic efficacy of intrathecal fentanyl and buprenorphine used along with 0.5% bupivacaine

Background: One of the primary aims of anaesthesia is to alleviate the patients’ pain and agony, there by permitting the performance of surgical procedures without any discomfort. Any expertise acquired in this field should be extended into the postoperative period, the period of severe, intolerable pain requiring attention. It is well known that when pain is treated pre-emptively, the amount of drug required is considerably less than which would be required, if treatment is delayed until the pain becomes apparent. Objectives: To evaluate the efficacy and safety of Buprenorphine (90 μg) and Fentanyl(25 μg) for intraoperative analgesia and postoperative pain relief, when administered intrathecally along with local anaesthetic agent 0.5% Bupivacaine (heavy). Study the characteristics of sensory and motor blockade, quality of block, and any side effects produced by combination of both drugs. Methods: Randomized, double blind, placebo controlled study of 120 pts; ASA I and II; aged between 15 - 60 years. Ethical committee approval, applied inclusion and exclusion criteria. Patients randomly divided in 3 groups of 40 each. Group A(control) Group B(Buprenorphine) and Group C( Fentanil). Postoperative pain evaluated by VAS. All figures in tables are expressed as mean ± SE. The results of data between the groups were analyzed statistically using unpaired t-test. A p<0.05 was considered significant and p<0.001 as highly significant. Results: All groups were comparable in relation to sex and age. The differences in mean pulse rate, mean respiratory rate, mean arterial pressure and oxygen saturation between the groups before and after administration of drugs were statistically insignificant (p>0.05). Onset of sensory and motor blockade was significantly rapid (p<0.05) in Fentanil group as compared to group A and B. None of the pts. had respiratory depression. Onset of sensory block was early in group C as compared to group A and B(1.26 ± 0.63, Vs 4.05±1.25 and 4.46±2.33 min) while time for two segment regression of sensory block was higher in group B(136.73±26.48 min) as compared to group A(115.5±11.62 min.) and group C(119.5±26.76 min.). The onset of motor block was early in group C(2.23± 1.47 min.) as compared to groups A(4.47 ± 2.23 min) and B(5.03± 2.58 min.). The mean duration of postoperative analgesia was higher in group B(10.34 ± 3.70 hrs) as compared to groups A(2.7 ± 0.78 hrs) and C(5.43 ± 1.31hrs). None of the patients in three groups had any statistically significant intra or postoperative side effects. Conclusion: From the observations of our study, it can be concluded that intrathecal administration of Buprenorphine and Fentanyl significantly enhances the onset of sensory analgesia. Doesn’t alter the characteristics of motor block. Prolongs the duration of sensory blockade. Provides excellent surgical anaesthesia and postoperative analgesia without any significant increase in side effects.