Safety and Efficacy of Low-dose Selective Spinal Anesthesia with Bupivacaine and Fentanyl as Compared to Intravenous Sedation and Port-Site Infiltration for Outpatient Laparoscopic Tubal Ligation: A Randomized Controlled Trial

BACKGROUND: Selective spinal anesthesia has been safely applied for short-duration outpatient gynecological laparoscopic procedure. However, this anesthesia technique is often inadequate and not tolerated by awake patients due to pneumoperitoneum and visceral manipulation. AIMS: We aimed to conduct a study to compare spinal anesthesia with bupivacaine, fentanyl, and i.v. sedation with i.v. sedation and laparoscopic port-site infiltration with local anaesthetic in outpatient laparoscopic tubal ligation procedures. SETTINGS AND DESIGN: 100 female patients posted for elective surgeries were recruited for a prospective single blind randomised control trial in a tertiary care center in two groups. MATERIALS AND METHODS: In Group S, patients receive intrathecal 3 mg hyperbaric bupivacaine 0.5% plus 20 microgram fentanyl along with intravenous (i.v.) fentanyl at 1μg.kg(-1).h(-1) and in Group C i.v. fentanyl at 1μg.kg(-1).h(-1) along with laparoscopic port site infiltration with 0.5% bupivacaine. Postoperatively, overall patient satisfaction, visual analog score (VAS) score, duration of motor blockade, sensory blockade, and time to attain discharge criteria and any adverse. STATISTICAL ANALYSIS: Continuous variables between the groups were compared by the independent t-test and Wilcoxon rank sum. Chi-square and Fisher exact test used for the categorical value. RESULTS: Overall VAS was significantly lower and patient satisfaction was higher in Group S than Group C. Time to oral intake was significantly prolonged in Group C 126.33 (±29.54) compared to group S 110.81 (±29.54). The requirement of total rescue analgesia (fentanyl) was significantly higher in Group C 2.0 (±0.6) μg.kg(-1) compared to group S 0.79 (±0.53) μg.kg(-1). Incidence of postoperative nausea vomiting (PONV) was significantly greater in Group C while incidence of pruritus was significantly greater in Group S. CONCLUSION: Low-dose intrathecal anesthesia with 3 mg bupivacaine and 20 μg fentanyl provided better analgesia, patient satisfaction and with less opioids consumption.