Spinal hyperbaric ropivacaine-fentanyl for day-surgery

Adequate intraoperative analgesia combined with faster mobilization might be achieved by replacing hyperbaric ropivacaine partly with fentanyl. Sixty spinal anesthesia patients were randomized into 2 groups of either fentanyl 20 μg mixed with hyperbaric ropivacaine 10 mg (group FR10) or hyperbaric r... Full description

Adequate intraoperative analgesia combined with faster mobilization might be achieved by replacing hyperbaric ropivacaine partly with fentanyl. Sixty spinal anesthesia patients were randomized into 2 groups of either fentanyl 20 μg mixed with hyperbaric ropivacaine 10 mg (group FR10) or hyperbaric ropivacaine 15 mg (group R15). Forty-five patients underwent inguinal hernia repair and 15 patients had lower extremity surgery. Sensory block was tested by pinprick, and motor block was tested by use of a modified Bromage scale at 5-minute intervals for 30 minutes, 15-minute intervals for 60 minutes, and at 30-minute intervals until full recovery. The groups did not differ significantly regarding success (27 of 30 [group FR10] and 29 of 30 [group R15]), median onset time (10 [5 to 25] v 10 [5 to 20] minutes) or median duration of T10 sensory block (55 [20 to 115] v 80 [5 to 170] minutes), respectively. Recovery from spinal block was significantly quicker in group FR10 than in group R15, recorded in ability to walk (2.5 hours v 3 hours [ P = .017]), full motor recovery (1 hour v 1.5 hour [ P < .001]), and sensory recovery to S1 (2.5 hours v 3.3 hours [ P = .026]). Pruritus occurred in 18 (60%) of group FR10 v 0 of group R15 patients ( P < .001). This symptom was mild in all except 1 patient, who received ondansetron 8 mg IV. In the OR, the groups did not differ hemodynamically: 9 (30%) of the group FR10 and 10 (33%) of the group R15 patients, respectively, required medication for hypotension and/or bradycardia. Full motor block (Bromage 3) developed less frequently ( P < .001) in group FR10 patients than in group R15 patients (1 [3%] v 14 [47%]), and the group FR10 patients recovered faster in a median time of 60 v 90 minutes ( P < .001). In both groups, sensory and motor blocks were more extensive on the operative side compared with the nonoperative side ( P < .001). Faster mobilization but equal onset and duration of analgesia were achieved with intrathecal hyperbaric ropivacaine 10 mg plus fentanyl 20 μg as compared with hyperbaric ropivacaine 15 mg.