Hyperbaric bupivacaine 0.5% versus hyperbaric bupivacaine 0.5% & fentanyl in spinal anaesthesia: Haemodynamic changes and adverse effects

Abstract

Cardiovascular system is the most important physiologic response to spinal anaesthesia. They are mediated by combined autonomic denervation and higher levels of neural blockade and the added effects of vagal nerve intervention. The level of sympathetic blockade determines the magnitude of cardiovascular responses to spinal anaesthesia. Higher the level of neural blockade the greater would be change in cardio-circulatory parameters. In the presence of partial sympathetic blockade a reflex increase in sympathetic activity occurs in sympathetically intact areas. The result is vasoconstriction that tends to compensate for peripheral vasodilatation taking place in sympatheticlly denervated areas. 100 patients belonging to American Society of Anaesthesiology (ASA) Grade-I & II physical status, scheduled for elective surgeries of lower abdomen and lower extremities aged between 18-60 years were included in this study. Hypotension was noted in 6 patients in group I and 5 patients in group II. One patient complained of itching (pruritis) over the neck and shoulders in group II and none in group I. Intrathecal fentanyl along with bupivacaine gives a more reliable anaesthesia, better operative conditions, patient comfort and prolonged duration of analgesia with minimal side effects.