COMPARATIVE EVALUATION OF INTRATHECAL ADMINISTRATION OF BUPRENORPHINE OR FENTANYL AS AN ADJUVANT TO LEVOBUPIVACAINE (HYPERBARIC) IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

Background: Using intrathecal adjuvants in spinal anesthesia aims to enhance analgesic efcacy and prolong the duration of sensory and motor blocks. Buprenorphine and fentanyl are commonly used adjuvants with distinct pharmacological proles, offering varying benets in terms of onset time and duration of analgesia. This study seeks to evaluate and compare the effectiveness and safety of these two adjuvants when combined with hyperbaric levobupivacaine in patients undergoing lower limb surgeries. Aims And Objectives: The study compared the efcacy and safety of intrathecal buprenorphine and fentanyl as adjuvants to hyperbaric levobupivacaine in patients undergoing lower limb surgeries. Materials And Methods: An analytical cross-sectional study was conducted at Sri Aurobindo Medical College and Post Graduate Institute, Indore, from 1st September 2022 to 1st February 2024. Eighty-four patients, aged 18 to 40 years with ASA grade 1 and 2 status, scheduled for lower limb surgeries under subarachnoid block were enrolled. Patients were randomly assigned to two groups: Group B (n=42) received intrathecal levobupivacaine 0.5% with 30 mcg buprenorphine, and Group F (n=42) received intrathecal levobupivacaine 0.5% with 25 mcg fentanyl. Sensory and motor block characteristics, intraoperative hemodynamic parameters, duration of postoperative analgesia, and adverse effects were assessed. Results: The demographic characteristics were comparable between the groups. The onset time of sensory block was signicantly faster in Group F (2.7 ± 0.6 minutes) compared to Group B (3.8 ± 1.3 minutes, p < 0.001). Conversely, the onset of motor block was quicker in Group B (7.7 ± 2.7 minutes) compared to Group F (10.2 ± 2.9 minutes, p < 0.001). Intraoperative hemodynamic parameters were similar between the groups. The duration of adequate postoperative analgesia was signicantly longer in Group B (422.2 ± 10.28 minutes) compared to Group F (288.6 ± 4.30 minutes, p < 0.001). Group B required fewer additional analgesic doses within the rst 24 hours postoperatively (mean 1.2 doses) compared to Group F (mean 2.1 doses, p < 0.001). Adverse effects were comparable between the groups, with no signicant differences. Conclusion: Both buprenorphine and fentanyl are effective and safe adjuvants to levobupivacaine for intrathecal anesthesia in lower limb surgeries. Buprenorphine offers a signicantly longer duration of postoperative analgesia, while fentanyl provides a faster onset of sensory block.