A prospective randomized controlled study comparing intrathecal bupivacaine combined with fentanyl and sufentanil in abdominal and lower limb surgeries

BACKGROUND: Hyperbaric bupivacaine along with either fentanyl or sufentanil as additive, has been widely used in spinal anesthesia. In the present study, we compared the analgesic effects of intrathecal fentanyl versus sufentanil combined with bupivacaine for surgical procedures over the abdomen and lower limbs. SETTINGS AND DESIGN: This was randomized controlled study conducted in a tertiary care hospital attached to a medical school. METHODS: Sixty American Society of Anesthesiologists I and II patients were randomized into three groups by sealed envelope technique. Group 1 was to receive bupivacaine with fentanyl; group 2 to receive bupivacaine with sufentanil and group 3 to receive bupivacaine with saline (control), intrathecally. The parameters checked were hemodynamic changes, onset and duration of sensory block, duration of analgesia and maximal sensory level achieved. STATISTICAL ANALYSIS: The data collected were analyzed using χ2 test and paired Student's t-test. RESULTS: The time taken for the onset of analgesia was longest in the control group followed by fentanyl group. The earliest onset of action of 9.35 ± 1.92 min was recorded in sufentanil group. Duration of sensory blockade and analgesia was longest for fentanyl group than the other groups. Adverse effects noted were more for sufentanil group but were self-limiting. CONCLUSION: Fentanyl with bupivacaine produced prolonged analgesia and delayed two-segment regression and demonstrated reduced incidence of complications as compared with intrathecal sufentanil. As the quality of analgesia was complete and comparable, fentanyl emerges as a better option for analgesia and it is much economical too when compared to sufentanil.