Abstract Background: Spinal anesthesia (SA) with adjuvants like fentanyl or buprenorphine improves block quality. The existing literature provides valuable insights but is limited by several factors, including a primary focus on a single surgical specialty. Aims and Objectives: This study assessed real-world hemodynamic and analgesic outcomes of fentanyl and buprenorphine in a diverse surgical population. Materials and Methods: This prospective observational study involved 128 adult patients undergoing elective lower abdominal and limb surgeries under SA. Patients scheduled for general, obstetric, orthopedic, or urologic procedures were included in this study. Subjects received 15 mg of hyperbaric bupivacaine 0.5% intrathecally, combined with either 20 µg of fentanyl or 60 µg of buprenorphine. Hemodynamic parameters were recorded at baseline and throughout the perioperative period. The onset of sensory and motor blockade was assessed, and postoperative pain was measured using the Visual Analog Scale. Any complications were documented. Results: Both adjuvants maintained stable hemodynamics, with no statistical significance ( P > 0.05), indicating cardiovascular safety. The fentanyl group showed a faster onset of block (6–7 min vs. 8–9 min for buprenorphine, P < 0.01). Buprenorphine provided longer postoperative analgesia (5–7 h) than those with fentanyl (3–5 h, P < 0.05). Rescue analgesia was more frequently needed in the fentanyl group (96.9% vs. 87.5%). Conclusion: Fentanyl and buprenorphine showed stable hemodynamic profiles in the perioperative period. The adjuvant should be chosen based on the surgical context, desired onset time, analgesia duration, and patient-specific factors to ensure optimal anesthetic and analgesic outcomes.
Kuppuraman et al. (2026) studied this question.