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Spinal anaesthesia can be intensified by adding low dose opioids along with intrathecal local anesthetics without an effect on sympathetic blockade. We sought to evaluate the safety and efficacy of intrathecal levobupivacaine plain versus levobupivacaine plus fentanyl in lower abdominal and lower limb surgeries. Materials and Methods: In a prospective randomized double blind study, 60 American Society of Anesthesiologists grades I and II patients of either sex, 18-55 years of age were enrolled for the study after obtaining Ethical Committee clearance and informed consent. They were randomly divided into two groups of 30 each, Group A2.5ml of 0.5% isobaric levobupivacaine + 0.5ml Normal saline and Group B-2.5 ml of 0.5% isobaric levobupivacaine + 25 μg fentanyl intrathecally. Sensory and motor block characteristics, haemodynamics and side effects were assessed. Results: The onset of sensory block and time to reach T10 level was rapid in Group B (2.10±0.75 and 5.6+1.22 min) in comparison to Group A (2.75±0.67 and 7.70+1.46min P < 0.0007). Most patients in Group B had maximum sensory block of T6 and a Bromage scale of 3 which was achieved earlier than in Group A(P=0.010).In Group A highest level of sensory block was T8 with Bromage scale of 2. The duration of both sensory and motor block was longer in Group B(165.5±12.05) (P<0.0001) compared to Group A(141.00±9.86 min). Data was analyzed using “Chi-square test” and “unpaired t-test.” Conclusion: Fentanyl added to Levobupivacaine results in early onset and prolonged duration of sensory and motor block with stable haemodynamics. Introduction Lower abdomen and lower limb procedures are most commonly performed surgeries. These surgeries are done on an elective/emergency basis and this helps in early rehabilitation and resuming of normal life. These procedures cause more pain. Hence it is essential to provide adequate intraoperative and postoperative analgesia. The incidence of cardiorespiratory complications is decreased and early ambulation and complete recovery is seen when good postoperative analgesia is provided leading to lesser medical cost. We can perform both regional anesthesia and general anesthesia for lower abdomen and lower limb surgeries. Spinal anesthesia is a simpler procedure when compared to epidural and is easily performed. It helps to avoid the problems of general anesthesia like intraoperative blood loss, stress response, polypharmacy. Spinal anesthesia also provides a faster onset of sensory and motor blockade with less failure rates, less postoperative morbidity and preservation of mental status and normal reflexes. A quest for search of newer and safer anesthetic agents in anesthesiology practice has been there always. Local anesthetics starting from older drugs like cocaine to newer ones like levobupivacaine have some advantages and disadvantages. Lignocaine used previously, has been banned for intrathecal use because of the risk of transient neurological symptoms. Bupivacaine a drug used regularly is known to cause cardiotoxicity and neurotoxicity on inadvertent intravascular injection. Levobupivacaine, a levorotatory isomer of bupivacaine has a good pharmacokinetic profile is effective and less cardiotoxic and neurotoxic. Therefore it is preferred for spinal anesthesia even in the elderly. Adjuvants like opioids (morphine, fentanyl), ketamine, clonidine, dexmedetomidine are added to intrathecal local anesthetics in order to potentiate the effects. Fentanyl, because of its increased lipophilic quality leads to a decreased rostral spread and is a safe drug for potentiation of local anesthetic effect. This study was undertaken to compare the effects of levobupivacaine and levobupivacaine with fentanyl in patients posted for lower abdomen and lower limb surgeries under spinal anesthesia. Article Info Received: 8th July, 2019 Accepted: 1st August, 2019 Published Online: 22nd August, 2019

indian journal of clinical anaesthesia

A comparative study between isobaric levobupivacaine and isobaric levobupivacaine with fentanyl in patients posted for lower abdominal and lower limb surgeries under spinal anaesthesia