Comparison of Spinal Anesthesia Bupivacaine Plus Epinephrine and Spinal Anesthesia Bupivacaine Plus, Fentanyl in the Duration of Anesthesia, Complications, and Hemodynamic Changes
| Author | Hassan Ali Hammod | en |
| Author | Seyed Khalil Pestehei | en |
| Author | Masoome Malek | en |
| Author | Afzal Shamsi | en |
| Author | Alireza Montaseri | en |
| Orcid | Seyed Khalil Pestehei [0000-0002-0538-8898] | en |
| Orcid | Masoome Malek [0000-0002-0479-5547] | en |
| Issued Date | 2025-07-31 | en |
| Abstract | Background: Spinal anesthesia is a widely used technique in orthopedic and other surgical procedures due to its safety and effectiveness. Bupivacaine is the most commonly used local anesthetic, but its use alone is limited by the duration and depth of sensory and motor blockade. To enhance anesthetic quality and minimize adverse effects, adjuvants such as epinephrine and fentanyl are often added. Objectives: The objective of this study was to compare the efficacy, safety, and clinical outcomes of epinephrine versus fentanyl as intrathecal adjuvants to bupivacaine in orthopedic surgeries, focusing on motor block duration, hemodynamics, and postoperative pain control. Methods: This quasi-experimental study was conducted on 100 patients undergoing femur and tibia surgeries under spinal anesthesia at a tertiary hospital in Iran. Participants were randomized into two groups: One received intrathecal bupivacaine with epinephrine, and the other received bupivacaine with fentanyl. Outcomes compared included the duration of anesthesia, postoperative pain scores, and incidence of complications. Results: The combination of bupivacaine with epinephrine resulted in a significantly longer duration of anesthesia (222.38 ± 17.48 minutes vs. 169.88 ± 15.57 minutes; P = 0.001) and higher rates of complete muscle relaxation (84% vs. 46%; P < 0.001). However, this group showed increased incidences of hypotension (16% vs. 0%; P < 0.001) and bradycardia (10% vs. 0%; P < 0.001). The bupivacaine-fentanyl group reported lower pain scores at all time points (e.g., 1.0 ± 0.0 vs. 1.3 ± 0.73 at 30 minutes; P = 0.005) but had higher pruritus rates (14% vs. 0%; P = 0.001). Conclusions: While bupivacaine combined with epinephrine extends the duration of anesthesia, it is associated with more hemodynamic disturbances. Bupivacaine with fentanyl offers superior postoperative analgesia and a more favorable safety profile, making it a suitable option for spinal anesthesia in lower limb surgery. | en |
| DOI | https://doi.org/10.5812/ans-163729 | en |
| Keyword | Spinal Anesthesia | en |
| Keyword | Bupivacaine | en |
| Keyword | Fentanyl | en |
| Keyword | Epinephrine | en |
| Keyword | Postoperative Pain | en |
| Keyword | Hemodynamics | en |
| Publisher | Brieflands | en |
| Title | Comparison of Spinal Anesthesia Bupivacaine Plus Epinephrine and Spinal Anesthesia Bupivacaine Plus, Fentanyl in the Duration of Anesthesia, Complications, and Hemodynamic Changes | en |
| Type | Research Article | en |
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