Study of use of intrathecal hyperbaric bupivacaine (2.5mg) with fentanyl for lower limb surgeries in high-risk geriatric patients

Research Article
Viraj, Ghoshal Pabitra, *Sutar Pratiksha, Pai Abhinav, K.S.Lakshmy and Bhakta Pavana
Intrathecal Anesthesia, Bupivacaine, Fentanyl, Geriatric, ASA III/IV

Background & Aims: In geriatric population spinal anesthesia is associated with a high incidence of hemodynamic fluctuations. Synergism between intrathecal opioids and low dose local anaesthetics have been used to achieve reliable spinal anesthesia with minimal hypotension. A single armed prospective study was conducted with an aim to establish a safe regime of intrathecal anaesthesia with opioid for ASA III and IV geriatric patients scheduled for lower limb surgery. Materials and Methods: After obtaining IEC approval and registering the study for CTRI CTRI/2022/07/044344 a total of 30 ASA grade III and IV geriatric patients, of either sex undergoing lower limb surgery under spinal anesthesia were enrolled. Patients received 0.5ml of hyperbaric 0.5% bupivacaine and 25mcg of fentanyl intrathecally. Statistical analysis was carried out using the chi-squared test or Fisher’s exact test, ANOVA, the Kruskal-Wallis test, Wilcoxon-Mann-Whitney U Test, Pearson's Correlation and Spearman Correlation. Results: All patients had satisfactory anesthesia. Out of 30 patients only 4 required (single episode) vasopressor support and other 4 had PONV. None of the patients required conversion to general anesthesia. Sensory level variability noted, which is statistically significant p value 0.0017 (<0.05), indicating variability based on patient characteristics. Conclusion: A dose of 2.5mghyperbaric bupivacaine with fentanyl provides optimal spinal anesthesia for short duration lower limb surgical intervention in high-risk geriatric patient, avoiding hemodynamic fluctuations and ensuring a stable perioperative and postoperative period.