Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries

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Thavat Chanchayanon Mareeya Chearong Piyaporn Vasinanukorn Natsana Withayanuphakorn Tidarat Sangkaew


Objective: We aimed to assess the efficacy, the incidence of hypotension and adverse consequences of using intrathecal hyperbaric bupivacaine in comparison to a combination of low dose hyperbaric bupivacaine and fentanyl, in geriatric patients undergoing urological surgeries.
Material and Methods: Our study was a prospective, triple-blinded and randomized controlled. One hundred and fortyeight geriatric participants scheduled for urological surgeries were randomly assigned into two groups: Group B (n=74) received intrathecal injection with 0.5% hyperbaric bupivacaine 1.5 milliliters (ml) alone (7.5 milligrams; mg), while Group F (n=74) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) plus 0.5 ml of fentanyl (25 micrograms; mcg) making up to a total volume of 1.5 ml.
Results: One hundred and forty-eight patients were included however, six patients were excluded from statistical analysis, due to an inadequate level of anesthesia; hence, 142 patients were analyzed. The incidence of hypotension in group B was: 9.7%, and in group F the percentage was 12.9%, respectively (p-value=0.74). There was no significant difference in regards to the highest sensory level in both groups. The anesthesia level in group B was Thoracic level 11 (T10-T12), and in group F it was 11 (T10-T12) (p-value=0.68), while the analgesia level in group B was Thoracic level 7 (T6-T8) with group F being a Thoracic level 6 (T6-T8) (p-value=0.16). The occurrence of bradycardia, and respiratory depression did not differ between the 2 groups.
Conclusion: Intrathecal administration of 5 mg of 0.5% hyperbaric bupivacaine, plus 25 mcg of fentanyl provided an adequate level of sensory blockade, but did not decrease the frequency of hypotension.


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Chanchayanon T, Chearong M, Vasinanukorn P, Withayanuphakorn N, Sangkaew T. Incidence of hypotension between Intrathecal Hyperbaric Bupivacaine with and without Fentanyl in Geriatric Patients Undergoing Urological Surgeries. Journal of Health Science and Medical Research [Internet]. 14Mar.2019 [cited 12Dec.2019];37(2):93-9. Available from:
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1. Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Low dose bupivacaine-fentanyl spinal anesthesia for transurethral prostatectomy. Anaesthesia 2003;58:526-30.

2. Hole A, Terjesen T, Breivig H. Epidural versus general anesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand 1980;24:279-87.

3. Rubin AP. Spinal anesthesia. In: Wildsmith JA, editor. Principles and practice of regional anesthesia. London: Churhill Livingstone; 1998;p.70-80.

4. Vaghadia H, McLeod DH, Mitchell GW, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg 1997;84:59–64.

5. Critchley LA. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996;51:1139–43.

6. Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 1997;85:99–105.

7. Singh I, Gupta M, Mahawar B, Gupta A. Comparison of effect of intrathecal sufentanil-bupivacaine and fentanyl bupivacaine combination on postoperative analgesia. Indian J Anaesth 2008;52:301-4.

8. Gautier PE, De Kock M, Van Steenberge A, Poth N, Lahaye-Goffart B, Fanard L, et al. Intrathecal ropivacaine for ambulatory surgery. Anesthesiology 1999;91:1239-45.

9. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanylbupivacaine for cesarean delivery. Anesthesiology 1989;71:535-40.

10. Maves TJ, Gebhart GF. Antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception in the rat. Anesthesiology 1992;76:91-9.

11. Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiology 1993;79:766-73.

12. Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Rostral spread of epidural morphine. Anesthesiology 1982;56:431-6.

13. Singh C, Trikha A, Saxena A. Spinal Anaesthesia with bupivacaine and fentanyl. J Anaesthesiol Clin Pharmacol 1999;15:291-4.

14. Chen TY, Tseng CC, Wang LK, Tsai TY, Chen BS, Chang CL. The clinical use of small-dose tetracaine spinal anesthesia for transurethral prostatectomy. Anesth Analg 2001;92:1020-3.

15. Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg 1995;80:730–4.

16. Kuusniemi KS, Pihlajamakin KK, Pitkanen MT, Helenius HY, Kirvela OA. The use of bupivacaine and fentanyl for spinal anesthesia for urologic surgery. Anesth Analg 2000;91:1452-6.

17. Gupta S, Sampley S, Kathuria S, Katyal S. Intrathecal sufentanil or fentanyl as adjuvants to low dose bupivacaine in endoscopic urological procedures. J Anaesthesiol Clin Pharmacol 2013;29:509-15.