Efficacy of intrathecal fentanyl versus buprenorphine as an adjuvant to isobaric levobupivacaine in lower limb surgeries: a comparative study

Abstract

Background: Fentanyl and buprenorphine are the most commonly used adjuvants in spinal anesthesia. There is paucity in literature regarding the comparison of these two adjuvants when used with levobupivacaine. Aim: This study aimed to compare the efficacy and safety of fentanyl and buprenorphine added to isobaric levobupivacaine. Materials and Methods: This prospective randomized double-blind study was undertaken on 60 patients between the ages of 18 and 65 years with the American Society of Anesthesiologists (ASA) physical status 1, 2, and 3 scheduled for lower limb surgery. Group LF (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 10 microgram (mcg) injection fentanyl and Group LB (n = 30) received 3-mL isobaric 0.5% levobupivacaine with 60 mcg injection buprenorphine. Characteristics of sensory and motor blockade, duration of postoperative analgesia, hemodynamic parameters, and adverse effects were recorded. Data were analyzed by appropriate statistical tests and a value of P 0.05). The onset of motor block, duration of sensory block, and duration of analgesia were significantly prolonged in Group LB than Group LF (P < 0.05). Six patients in Group LF and three patients in Group LB developed nausea, although the difference was not statistically significant (P = 0.2801). None of the patients in either of the study groups had adverse effects such as bradycardia, hypotension, pruritus, or respiratory depression. Conclusion: Combinations of 0.5% isobaric levobupivacaine (3 mL) with fentanyl (10 mcg) and buprenorphine (60 mcg) show a good safety profile when administered intrathecally, although combination of levobupivacaine–buprenorphine is superior in terms of prolonged sensory block and longer duration of postoperative analgesia.

Keywords

• buprenorphine
• fentanyl
• intrathecal
• isobaric
• levobupivacaine