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Ambulatory anesthesia aims at early discharge with minimal side effects. The study aimed to establish the efficacy of 7.5 vs 10 mg of hyperbaric bupivacaine (bupivacaine H) for spinal anesthesia (SA) for inguinal hernia repair in terms of onset of block, maximum surgical level achieved, motor block, hemodynamic parameters, recovery profile, and complication rate. Materials and methods: Anesthesia records of 200 male patients who underwent inguinal hernia repair under SA were studied. About 100 patients who received SA with 1.5 mL of 0.5% bupivacaine H + 25 μg fentanyl + 1 mL normal saline (NS) were labeled group L and 100 patients who received 2 mL of 0.5% bupivacaine H + 25 μg fentanyl + 0.5 mL NS were labeled group H. All patients were given SA using 25G Quincke’s needle at L3/4 or L4/5 level. Sensory level was assessed with pinprick and motor blockade using modified Bromage scale (MBS). Hemodynamic parameters, sensory level, and motor blockade were noted every 5 minutes for first 15 minutes and every 15 minutes till the complete recovery of motor blockade. Analgesic requirement and rate of conversion to general anesthesia (GA) were noted. Results: The time for onset of action in group L vs group H was 4.7 ± 1.57 minutes vs 4.46 ± 0.95 minutes, which was not significant. However, the two segment regression time was 71.84 ± 8.02 minutes vs 93.70 ± 6.60 minutes in groups L vs H (p-value < 0.05), time to return to S1 was 158.5 ± 13.8 minutes vs 196 ± 31.68 minutes (p-value < 0.05), time to ambulation was 182 ± 15.80 minutes vs 304 ± 47.88 minutes (p-value 0.05), time to void was 198.37 ± 18.15 minutes vs 325.4 ± 53.73 minutes (p-value < 0.05), and time to home readiness was 293.4 ± 29.39 minutes vs 440.20 ± 37.93 minutes (p-value < 0.5). The rate of complications was comparable in both groups and the rate of conversion to GA was nil. Group L had superior hemodynamic stability. Conclusion: About 7.5 mg of 0.5% bupivacaine H with fentanyl offers excellent anesthesia for inguinal hernia repair in terms of adequate anesthesia, better hemodynamic stability, reduced complications, and early discharge vs 10 mg of bupivacaine H with fentanyl; hence it is ideal for ambulatory surgery.

research and innovation in anesthesia

Low-dose Bupivacaine with Fentanyl for Spinal Anesthesia during Ambulatory Inguinal Hernia Repair Surgery: A Comparison between 7.5 and 10 mg of 0.5% Hyperbaric Bupivacaine—A Retrospective Study