ASSESSMENT OF PREMIXED VERSUS SEQUENTIAL ADMINISTRATION OF HYPERBARIC LEVOBUPIVACAINE WITH FENTANYL FOR SENSORY EFFECT OF SPINAL ANAESTHESIA IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES
Jul 2026· Genetics and Molecular Research· 0 citations· 7 references
TL;DR
Sequential intrathecal administration of hyperbaric levobupivacaine and fentanyl provides faster onset and longer duration of sensory blockade, improved haemodynamic stability, prolonged postoperative analgesia, and reduced analgesic consumption compared with premixed administration.
Abstract
Background: Spinal anaesthesia is widely employed for elective lower abdominal surgeries because of its rapid onset, reliable sensory blockade, excellent muscle relaxation, and favourable recovery profile. Hyperbaric levobupivacaine is increasingly preferred due to its reduced cardiotoxicity and improved safety profile compared with racemic bupivacaine. Intrathecal fentanyl is commonly used as an adjuvant to enhance block quality and postoperative analgesia. However, limited evidence exists regarding whether sequential administration of hyperbaric levobupivacaine and fentanyl offers advantages over premixed administration in terms of sensory block characteristics, haemodynamic stability, and postoperative analgesia. Methods: This prospective observational comparative study was conducted in the Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, between October 2024 and October 2025. A total of 58 patients aged 18 60 years belonging to ASA physical status I and II and undergoing elective lower abdominal surgeries under spinal anaesthesia were enrolled. Participants were allocated into two groups of 29 patients each. Group S received sequential intrathecal administration of hyperbaric levobupivacaine followed by fentanyl, whereas Group M received a premixed intrathecal solution of the same drugs. Sensory block characteristics, haemodynamic parameters, and postoperative analgesic outcomes were assessed and compared between the groups. Results: Baseline demographic and clinical characteristics were comparable between groups. The onset of sensory block was significantly faster in Group S than in Group M (3.72 ± 0.81 vs. 4.45 ± 0.90 minutes; p=0.003). The duration of sensory blockade was significantly prolonged in Group S, with regression to the L1 dermatome occurring at 103.28 ± 11.98 minutes compared with 91.86 ± 10.95 minutes in Group M (p<0.001). Mean arterial pressure was significantly higher in Group S (83.52 ± 6.21 mmHg) than in Group M (79.90 ± 6.84 mmHg; p=0.031). The incidence of hypotension (17.24% vs. 37.93%) and vasopressor requirement (13.79% vs. 34.48%) were lower in Group S. Postoperative analgesia was significantly superior in Group S, with a longer time to first rescue analgesia (198.52 ± 26.21 vs. 162.48 ± 23.95 minutes; p<0.001) and lower total analgesic consumption (108.97 ± 27.84 vs. 146.21 ± 32.59 mg; p<0.001). Conclusion: Sequential intrathecal administration of hyperbaric levobupivacaine and fentanyl provides faster onset and longer duration of sensory blockade, improved haemodynamic stability, prolonged postoperative analgesia, and reduced analgesic consumption compared with premixed administration. Sequential administration may therefore represent a simple and effective strategy for optimizing spinal anaesthesia in elective lower abdominal surgeries.
Dexmedetomidine was found to be a superior adjuvant to epidural bupivacaine compared to clonidine due to better sedation, prolonged postoperative analgesia, and effectivehaemodynamic stability with manageable adverse effects.
Dr. Mahilamani, Dr. Vijay Balan.P· Asian Journal of Medical Res...· 0 citations
Introduction: Spinal Anaesthesia (SA) is a suitable Regional Anaesthesia (RA) for lower limb surgery, but is limited by its comparatively short analgesic duration. Adjuvants like fentanyl and dexmedetomidine can be administered intrathecally with local anaesthetics like ropivacaine to assist in modulating block parameters, extend the duration of analgesia and decrease systemic administration of opioids.
Aim: To compare and evaluate the safety and efficacy of intrathecal fentanyl and dexmedetomidine as adjuvants to ropivacaine in lower limb orthopaedic surgery.
Materials and Methods: This double-blinded, randomised controlled study was carried out at the Department of Anaesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research (DMIHER), Sawangi (Meghe), Wardha, Maharashtra, India. It was performed in 60 American Society of Anaesthesiologists (ASA) I-II patients aged 18-50 years undergoing elective lower limb operations. The patients were divided into two groups: Group-RD was administered 15 mg 0.5% hyperbaric ropivacaine with 10 μg dexmedetomidine and Group-RF was administered 15 mg 0.5% hyperbaric ropivacaine with 20 μg fentanyl. Haemodynamic parameters, sensory and motor block characteristics, sedation {as measured by the Ramsay Sedation Score (RSS)}. Duration of analgesia and sideeffects were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v22.0 and GraphPad Prism v6.0 and p<0.05 was considered statistically significant.
Results: The mean age was 38.43±8.31 years in GroupRF and 37.27±8.75 years in Group-RD. Group-RD showed a significantly earlier onset of sensory block (4.33±0.64 min vs 5.58±0.59 min). Motor block onset was also earlier in Group-RD (5.04±0.75 min) than in Group-RF (7.57±0.60 min), with a longer motor block duration (207.26±6.58 min vs 148.9±8.22 min). Postoperative analgesia lasted significantly longer in Group-RD (391.86±9.89 min) compared with Group-RF (213.3±3.79 min). Haemodynamic parameters remained clinically stable in both groups, with only slight transient decreases in PR and blood pressure and no significant bradycardia or hypotension.
Conclusion: Dexmedetomidine is a better adjuvant to ropivacaine compared to fentanyl in SA. It provides better onset, longer sensory and motor block duration and increased analgesia without inducing further haemodynamic instability or respiratory depression.
Akansha Singhal, Karuna Taksande· Journal of Clinical and Diag...· 0 citations
Background:Intrathecal adjuvants are commonly used to improve the quality and duration of spinal anesthesia in lower limb orthopedic surgeries. Clonidine, an α2-adrenergic agonist, prolongs sensory and motor blockade and postoperative analgesia when combined with local anesthetics; however, the optimal intrathecal dose of clonidine with hyperbaric levobupivacaine remains uncertain.Objectives:To evaluate and compare the effects of intrathecal clonidine (15 μg and 30 μg) as an adjuvant to 0.5% hyperbaric levobupivacaine in patients undergoing lower limb orthopedic surgeries.Methods:This prospective, randomized, double-blind study included 99 ASA I–II patients undergoing elective lower limb orthopedic surgery under spinal anesthesia. Patients were randomly allocated into three groups (n=33 each): Group A received hyperbaric levobupivacaine with saline, Group B received levobupivacaine with clonidine 15 μg, and Group C received levobupivacaine with clonidine 30 μg. Sensory and motor block characteristics, duration of postoperative analgesia, hemodynamic parameters, postoperative Visual Analog Scale (VAS) scores, and adverse effects were evaluated and compared among the groups.Results:The onset of sensory and motor blockade was significantly faster in the clonidine groups, particularly in Group C (P < 0.001). Time to attain maximum sensory and motor blockade was also significantly reduced in Group C. Duration of motor block and postoperative analgesia increased with increasing clonidine dose. Mean duration of analgesia washighest in Group C (360.76 ± 55.21 min), followed by Group B (300.68 ± 43.20 min) and Group A (255.80 ± 33.61 min) (P < 0.001). Postoperative VAS scores at 4 hours were significantly lower in Group C. Although intraoperative heart rate and blood pressure were lower in the clonidine groups, the changes remained clinically manageable.Conclusion:Intrathecal clonidine with hyperbaric levobupivacaine improved block characteristics and prolonged postoperative analgesia in a dosedependent manner. Clonidine 30 μg provided longest analgesia but caused greater, clinically manageable hemodynamic effects.
Dr. Neha Singla, Dr. Vikramjeet Arora· Asian Journal of Medical Res...· 0 citations
Background:Epidural anaesthesia is widely used for lower limb orthopaedic surgeries because of its ability to provide effective intraoperative anaesthesia and prolonged postoperative analgesia. Addition of adjuvants such as dexmedetomidine, clonidine, and fentanyl toepidural local anaesthetics improves block characteristics and haemodynamic stability. This study was conducted to compare the effects of dexmedetomidine, clonidine, and fentanyl on intraoperative haemodynamics when used as adjuvants to epidural ropivacaine.Methodology:This randomized prospective comparative study was conducted in the Department of Anaesthesiology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, from February 2025 to November 2025. A total of 45 ASA grade I and II patients aged 20–60 years undergoing lower limb orthopaedic surgeries under epidural anaesthesia were randomly divided into three groups of 15 each. Group A received ropivacaine with dexmedetomidine, Group B received ropivacaine with clonidine, and Group C received ropivacaine with fentanyl. Intraoperative haemodynamic parameters, onset and duration of sensory and motor blockade, analgesia, and adverse effects were assessed.Results:A statistically significant fall in systolic, diastolic, and mean arterial pressure was observed in Groups B and C from 15 to 120 minutes after epidural block (p<0.05). Dexmedetomidine demonstrated better haemodynamic stability compared to clonidine and fentanyl groups. All three groups provided effective anaesthesia and satisfactory analgesia with manageable adverse effects.Conclusion:Dexmedetomidine, clonidine, and fentanyl are effective epidural adjuvants in lower limb orthopaedic surgeries. Dexmedetomidine showed superior haemodynamic stability and prolonged analgesic effect with minimal adverse effects.
Dr. Sreekala, Dr. Subhasan JV· Asian Journal of Medical Res...· 0 citations
Background: Effective postoperative pain management is essential following lower limb orthopedic surgeries, as inadequate analgesia may delay mobilization, prolong hospital stay, and adversely affect patient recovery. Intrathecal buprenorphine is a commonly used opioid adjuvant that enhances the duration and quality of spinal anesthesia. However, the optimal dose capable of providing prolonged analgesia while maintaining safety remains uncertain. Methods: This prospective observational study was conducted among 60 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia. Patients were allocated into two groups of 30 each. Group A received 30 μg intrathecal buprenorphine with 0.5% hyperbaric bupivacaine, while Group B received 75 μg intrathecal buprenorphine with 0.5% hyperbaric bupivacaine. Sensory and motor block characteristics, duration of postoperative analgesia, Visual Analogue Scale (VAS) scores, rescue analgesic requirements, hemodynamic parameters, and adverse effects were evaluated and compared between groups. Results: The onset of sensory block was significantly faster in Group B than Group A (3.2 ± 0.7 vs 3.8 ± 0.9 minutes; p=0.02). The duration of sensory block was significantly prolonged in Group B (280 ± 30 vs 220 ± 25 minutes; p<0.001). Similarly, motor block duration was significantly longer in Group B (250 ± 25 vs 200 ± 20 minutes; p<0.001). The duration of postoperative analgesia was significantly greater in patients receiving 75 μg buprenorphine (520 ± 50 minutes) compared with those receiving 30 μg buprenorphine (360 ± 40 minutes; p<0.001). Time to first rescue analgesia was prolonged (525 ± 48 vs 365 ± 42 minutes; p<0.001), and rescue analgesic requirements were significantly lower in Group B. Postoperative VAS scores remained significantly lower in Group B from the second postoperative hour onward. Hemodynamic parameters were comparable between groups, and no significant differences were observed in adverse effects. No patient developed respiratory depression. Conclusion: Intrathecal buprenorphine at a dose of 75 μg provided superior sensory and motor block characteristics, prolonged postoperative analgesia, lower postoperative pain scores, and reduced rescue analgesic requirements compared with 30 μg buprenorphine. Both doses demonstrated comparable hemodynamic stability and safety profiles. Therefore, 75 μg intrathecal buprenorphine appears to be a more effective adjuvant to hyperbaric bupivacaine for lower limb orthopedic surgeries.
Unknown authors· Genetics and Molecular Resea...· 0 citations
Background: Spinal anaesthesia is a well-established anaesthetic technique due to its quick onset and reliable sensory-motor inhibition. However, limited postoperative analgesia remains a major drawback of bupivacaine-based subarachnoid block. The addition of intrathecal adjuvants has been explored to improve block quality and extend analgesic duration. Among these, α₂-adrenergic agonists such as dexmedetomidine and clonidine have demonstrated favourable effects on anaesthetic performance. Owing to its greater α₂-receptor selectivity, dexmedetomidine may offer advantages over clonidine in enhancing spinal anaesthesia outcomes. Objective: To compare the efficacy and safety of dexmedetomidine and clonidine as intrathecal adjuvants to hyperbaric bupivacaine in spinal anaesthesia. Methods: This study was designed as a prospective randomized comparative trial at Combined Military Hospital, Dhaka, between December 2019 and December 2020. Study population consisted of adult patients (n = 120) undergoing elective infraumbilical surgery with spinal anaesthesia. were registered and randomly split into two groups equally. Group A received 10 mg of 0.5% hyperbaric bupivacaine combined with dexmedetomidine 5 µg, whereas Group B received the same dose of bupivacaine with clonidine 30 µg. Outcomes assessed included onset and duration of sensory and motor blockade, duration of postoperative analgesia, haemodynamic variables, and treatment-related adverse events. Results: Patients receiving dexmedetomidine exhibited a significantly shorter time to peak sensory blockade compared with those receiving clonidine (2.13±0.54 vs 3.52±0.34 minutes; p<0.001). Similarly, complete motor blockade was achieved earlier in the dexmedetomidine group (2.93±0.43 vs 4.42±0.34 minutes; p<0.001). Dexmedetomidine was also associated with significantly prolonged sensory regression time, delayed motor recovery, and extended postoperative analgesia (all p<0.001). The mean duration before rescue analgesia was required was 544.5±17.6 minutes in Group A and 423.5±16.6 minutes in Group B. Haemodynamic measurements remained stable in both groups, and the incidence of adverse effects was comparable, with no episodes of clinically significant respiratory depression or excessive sedation. Conclusion: Low-dose intrathecal dexmedetomidine provided superior block characteristics and longer postoperative analgesia than clonidine while maintaining stable hemodynamic and safety profiles. It appears to be an effective adjuvant to hyperbaric bupivacaine with a comparable safety profile in subarachnoid anesthesia.
Mohammad Abedur Reza, Tahmina Bhuiyan, Meryem Kamal et al.· Islami Bank Medical College...· 0 citations