EFFICACY OF INTRATHECAL BUPRENORPHINE AS AN ADJUVANT TO HYPERBARIC LEVOBUPIVACAINE IN INFRA-UMBILICAL SURGERIES: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY
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Keywords
Subarachnoid block; Infraumbilical surgeries; Levobupivacaine; Buprenorphine; Sensory and motor block.
Abstract
Background: Subarachnoid block is a widely used anesthetic technique for infraumbilical surgeries due to its rapid onset and effective blockade. Levobupivacaine, a safer enantiomer of bupivacaine, is commonly employed in spinal anesthesia. However, single-agent spinal anesthesia may not always provide optimal analgesia. Intrathecal adjuvants like buprenorphine have been explored to enhance spinal anesthesia quality and prolong analgesia. This study compares intrathecal levobupivacaine 0.5% (heavy) alone versus with 60 mcg buprenorphine in terms of sensory-motor blockade, hemodynamic stability, side effects, and postoperative analgesia.
Methods: This prospective, randomized, double-blind, unicentric study was conducted in a tertiary care center in Maharashtra from September 2022 to August 2024. A total of 100 ASA grade I & II patients (18-65 years, 40-80 kg) scheduled for elective lower abdominal or limb surgeries were included and divided into two groups: Group L (levobupivacaine 3.3 ml + 0.2 ml NS) and Group L+B (levobupivacaine 3.3 ml + 60 mcg buprenorphine). Hemodynamic parameters, sensory and motor block characteristics, intraoperative side effects, and postoperative analgesia were assessed.
Results: Both groups were comparable in demographics and surgical duration. Sensory and motor block onset was significantly faster in Group L+B, with prolonged blockade duration (p<0.05). VAS scores were significantly lower in Group L+B at 1 and 2 hours (p=0.0001). Hemodynamic parameters remained stable, with no significant differences (p>0.05). The need for rescue analgesia was significantly delayed in Group L+B (p=0.0001).
Conclusion: Intrathecal buprenorphine 60 mcg enhances the effects of levobupivacaine, leading to faster onset, prolonged sensory-motor blockade, and superior postoperative analgesia without significant hemodynamic instability or adverse effects. It is a viable alternative to levobupivacaine alone for infraumbilical surgeries.
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Dr. Rashmi Kumari
Senior Resident, Department of Anesthesiology, Government Medical College, Nagpur, Maharashtra, India.
Dr. Ranjeeta Tambey
Associate Professor, Department of Anesthesiology, Government Medical College, Nagpur, Maharashtra, India.
Dr. Ijya Pande
Senior Resident, Department of Anesthesiology, Government Medical College, Nagpur, Maharashtra, India.