Key result
Addition of 25μg fentanyl to 2.5 mg bupivacaine prolonged sensory spinal block and reduced early post-operative analgesic requirements compared to 5 mg bupivacaine alone.
Why the study?
Minor anal surgeries often require surgical intervention with spinal anesthesia as the optimal option, but the efficacy of combining an ultra-dose of intrathecal bupivacaine with fentanyl needed assessment.
Does the addition of fentanyl to ultra-dose bupivacaine improve analgesia and hemodynamics in patients undergoing ambulatory anorectal surgery?
RCT (n=200)
Randomized
Does the addition of fentanyl to ultra-dose bupivacaine improve analgesia and hemodynamics in patients undergoing ambulatory anorectal surgery?
Adding fentanyl to ultra-low dose bupivacaine for spinal anesthesia in anorectal surgery improves postoperative analgesia and hemodynamic stability without delaying discharge.
May support ultra-low-dose spinal anesthesia for outpatient anal surgery; hypothesis-generating and needs larger confirmatory trials.
Background: Minor Anal surgeries such as piles or fissures are common problems among populations which sometimes need surgical interventions and spinal anesthesia is the optimal option for these procedures. Objective: To assess the efficacy of combination of ultra-dose of intrathecal Bupivacaine plus fentanyl as an analgesic procedure for out-patient anal surgeries. Patients and Methods: After approval by the local ethical committee, a prospective, controlled, clinical, randomized study was carried out on 200 patients, and randomly allocated into two equal groups: Group A: received (2.5 mg) 0.5% bupivacaine plus (25μg) fentanyl, and Group B: received 5 mg 0.5% bupivacaine alone. An informed consent was taken from every patient subjected to this study. Results: These studies showed that hemodynamics were more stable in (Fentanyl + Bupivacaine) group than in Bupivacaine only group. Usage of Fentanyl decreased postoperative pain and analgesic consumption in the first 6 hours after surgery along with longer pain free period compared to patients who were given Bupivacaine group. Conclusion: Addition of (25μg) fentanyl to (2.5 mg) 0.5% bupivacaine prolonged the duration of sensory spinal block, and reduced the analgesic requirement during the early post-operative period without increasing the incidence of opioid-related side-effects except pruritus, or delaying hospital discharge in patients undergoing ambulatory anorectal surgery in comparison to using 5 mg 0.5% bupivacaine alone.
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Al-Bahar et al. (2021) conducted an RCT in Out-patient anal surgeries (n=200). Bupivacaine plus fentanyl vs. 5 mg 0.5% bupivacaine alone was evaluated on Postoperative pain and analgesic consumption. Addition of 25μg fentanyl to 2.5 mg bupivacaine prolonged sensory spinal block and reduced early post-operative analgesic requirements compared to 5 mg bupivacaine alone.
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