Hemodynamic changes and recovery in unilateral spinal anesthesia using bupivacaine and bupivacaine + fentanyl combinations in outpatient inguinal hernia surgery
Liver Transplant Intensive Care Unit, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye
Keywords: Bupivacaine, fentanyl, hemodynamic change.
Objectives: The purpose of this study was to compare the hemodynamic changes and differences in recovery after bupivacaine and bupivacaine+fentanyl combinations in unilateral spinal anesthesia in patients to be undergoing outpatient inguinal hernia surgery.
Patients and methods: Between January 2004 and January 2005 a total 60 American Society of Anesthesiologists (ASA) I-II group patients (57 males, 3 females; mean age: 45.9±16.1 years; range, 19 to 76 years) who were scheduled for outpatient inguinal hernia surgery were included in the study. The patients were divided into three groups of 20 at random. All patients were given 7 mL/kg of Ringer's lactate solution for 30 min before the operation. Group 1 received 7.5 mg 0.5% hyperbaric bupivacaine (1.5 mL)+0.5 mL isotonic (0.5 mL), Group 2 received 7.5 mg 0.5% hyperbaric bupivacaine (1.5 mL)+25 mcg fentanyl (0.5 mL), Group 3 received 10 mg of 0.5% hyperbaric bupivacaine (2 mL) within 90 seconds. Sensory block levels of the patients in the groups were evaluated with a pin-prick test and motor block levels were evaluated with the Bromage scale.
Results: Age, height, weight, operation time, ASA physical status, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), peak heart rate (HR), oxygen saturation among the groups, no statistically significant difference was found in terms of the maximum level of the sensory block on the side to be operated, the regression time of two dermatomes of sensory block were found to be significantly lower in Group 1 compared to Groups 2 and 3. No significant difference was found in terms of maximum sensory block level and motor block level on the contralateral side in all three groups. The time to the disappearance of motor block was significantly longer in Group 3 compared to Groups 1 and 2. In all three groups, there was no statistically significant difference in hemodynamic effects. Group 1 was inadequate in terms of perioperative anesthesia quality. During the operation, additional iv analgesia and sedation support were provided. The perioperative anesthesia quality of Group 2 and 3 was sufficient. Although recovery and standing time was shorter in Group 2 than in Group 3, urinary retention was found to be higher.
Conclusion: In outpatient inguinal hernia surgery, Group 1 with 7.5 mg 0.5% hyperbaric bupivacaine should not be preferred due to insufficient anesthesia quality, Group 2 with 25 mcg fentanyl added to 7.5 mg 0.5% hyperbaric bupivacaine and Group 2 with 10 mg 0.5% hyperbaric bupivacaine are alternatives to each other. However, we concluded that Group 3 was more advantageous because urinary retention was higher in the group with fentanyl supplementation.
Cite this article as: Ocak İ. Hemodynamic changes and recovery in unilateral spinal anesthesia using bupivacaine and bupivacaine + fentanyl combinations in outpatient inguinal hernia surgery. D J Med Sci 2022;8(1):19-25.
The study protocol was approved by the Haydarpaşa Numune Training and Research Hospital Ethics Committee (2003). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
The author declared no conflicts of interest with respect to the authorship and/ or publication of this article.
The author received no financial support for the research and/or authorship of this article.