Hemodynamic stability with intrathecal fentanyl alone in laparoscopic hysterectomies under general anesthesia - A pilot study

Background: Laparoscopic surgeries have become one of the most common procedures performed on an outpatient basis and for sicker patients, rendering anesthesia for laparoscopy technically difficult and challenging. This study is done to evaluate the efficacy of intrathecal fentanyl in maintaining the hemodynamics in patients undergoing laparoscopic hysterectomies under general anesthesia (GA). Materials and Methods: Sixty patients classified as American Society of Anesthesiologists (ASA) physical status I and II, 30‑50 years of age, and posted for elective laparoscopic hysterectomies under GA were selected. Patients were randomly divided into two groups of 30 each. Group 1 received intrathecal fentanyl 25 μgm diluted to 3 mL with normal saline (NS) before GA and Group 2 received intravenous (IV) fentanyl 2 μgm/kg before GA. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), peripheral capillary oxygen saturation (SpO2), and electrocardiogram (ECG) were recorded before induction, after intubation, at 15 min, at 30 min, and every 30 min thereafter till the end of the surgery. Statistical Analysis: The results obtained in the study are presented as mean ± standard deviation (SD) in tabulated form and statistical analysis was done with SPSS software version 17 using Student’s t‑test. Results: In this present study, we found that HR, SBP, DBP, and MAP in both the groups were not significant after intubation for up to 15 min. Once pneumoperitoneum was achieved HR, SBP, DBP, and MAP were found to be significantly higher in Group 2 compared to that of Group 1 (P < 0.001). The time for first rescue medication was significantly shorter in Group 2 compared to that of Group 1. There were no side effects observed in any of the groups. Conclusion: From this study, we conclude that intrathecal fentanyl 25 μgm is very effective in controlling the intraoperative hemodynamics during laparoscopic hysterectomies under GA. We also observed better postoperative analgesia, with prolonged time for rescue analgesia.