Effects of fentanyl on isobaric ropivacaine in subarachnoid anaesthesia for lower abdominal and lower extremity surgeries

Murali C.H., Laxmi Narsaiah G.


Background:The addition of fentanyl to ropivacaine has shown to improve the quality of analgesia without compromising its benefits such as early mobilization and early voiding. This study evaluated the effects of adding fentanyl 25 mcg to isobaric ropivacaine 0.75% for spinal anaesthesia with regards to the onset of sensory block, maximum sensory level reached and the time to achieve it, time to two dermatome segment regression, onset of motor block, time for maximum motor blockade, duration of motor block, hemodynamic parameters and incidence of side effects.

Methods: Hundred patients, male and female, ASA I or ASA II, aged 18 to 65 years scheduled for elective lower abdominal and lower extremity surgeries were randomized into two groups. Group R (control group) received 0.75% isobaric ropivacaine 22.5 mg (3 ml) and Group RF (study group) received 0.75% isobaric ropivacaine 22.5 mg (3 ml) and 25 mcg of fentanyl (0.5 ml). Intra operatively, sensory blockade was assessed by pin-prick method and motor parameters were assessed by modified Bromage scale at different time intervals. Haemodynamic parameters were monitored and side effects were also recorded

Results: Both groups were comparable with respect to age, height, weight and duration of surgery. There was no significant difference in hemodynamics, onset of sensory and motor block, peak level of block, recovery from motor block, return of micturition and incidence of side effects with the addition of fentanyl to ropivacaine. There was a significant prolongation of the duration of sensory block (250.8±20.7 VS 362.1±15.1* min) and postoperative analgesia (320.56+15.32 VS462.41±38.42 *min) in Group RF (P < 0.001).

Conclusions: It was concluded that the addition of 25 mcg fentanyl to 22.5mg of 0.75% isobaric ropivacaine for spinal anaesthesia significantly increases the duration of sensory block and decreases the rescue of analgesia with better hemodynamic stability, early recovery and mobilization.



Spinal anaesthesia, Isobaric Ropivacaine, Fentanyl, Sensory block, Analgesia

Full Text:



Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;(94):888-906

Kuthiala G, Chaudhary G. Ropivacaine: a review of its pharmacology and clinical use. Indian J Anaesth. 2011(55):104-10.

Leone S, Di Cianni S, Casati A, Fanelli G. Pharmacology, toxicology, and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed. 2008;(79):92-105.

Agarwal A, Verma RK, Srivastava S. Ropivacaine - The latest local anesthetic in the Indian market. J Anaesth Clin Pharmacol. 2010;(26):223-8.

Wille M. Intrathecal use of ropivacaine: a review. Acta Anaesthesiol Belg. 2004;(55):251-9.

Wong JO, Tan TD, Leung PO, Tseng KF, Cheu NW, Tang CS. Comparison of the effect of two different doses of 0.75% glucose-free ropivacaine for spinal anesthesia for lower limb and lower abdominal surgery. Kaohsiung J Med Sci. 2004;(20):423-30.

Gupta K, Singh S, Sharma D, Gupta PK, Krishan A, Pandey M N. Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine for infraumbilical surgery under subarachnoid block: a prospective study. Saudi J Anaesth. 2014;(8):64-8.

Nuray CE, Berrin G. A comparison of the effects of intrathecal ropivacaine and bupivacaine during cesarean section. Turk J Med Sci. 2011;(41):219-81.

Parlow JL, Money P, Chan PS, Raymond J, Milne B. Addition of opioids alters the density and spread of intrathecal local anesthetics? An in vitro study. Can J Anaesth. 1999;(46):66-70.

Koltka K, Uludag E, Senturk M, Yavru A, Karadeniz M, Sengul T, et al. Comparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery. Anaesth Intensive Care. 2009;(37):923-8.

Seetharam KR, Bhat G. Effects of isobaric ropivacaine with or without fentanyl in subarachnoid blockade: a prospective double-blind, randomized study. Anesth Essays Res. 2015;9(2):173-7.

Boztug N, Bigat Z, Ertok E, Erman M. Intrathecal ropivacaine versus ropivacaine plus fentanyl for out-patient arthroscopic knee surgery. J Int Med Res. 2005;(33):365-71.

Sanli S, Yegin A, Kayacan N, Yilmaz M, Coskunfirat N, Karsli B. Effects of hyperbaric spinal ropivacaine for caesarean section: With or without fentanyl. Eur J Anaesthesiol. 2005;(22):457-61.

Andrew H. Intrathecal opioids in the management of acute postoperative pain. Oxford J. 2008;(3):81-5.

Yegin A, Sanli S, Hadimioglu N, Akbas M, Karsli B. Intrathecal fentanyl added to hyperbaric ropivacaine for transurethral resection of the prostate. Acta Anaesthesiol Scand. 2005;(49):401-5.

Jagtap S, Chhabra A, Dawoodi S, Jain A. Comparison of intrathecal ropivacaine-fentanyl and bupivacaine-fentanyl for major lower limb orthopaedic surgery: a randomised double-blind study. Indian J Anaesth. 2014;(58):442-6.

Chung CJ, Yun SH, Hwang GB, Park JS, Chin YJ. Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery. Reg Anesth Pain Med. 2002;(6):600-3.

Layek A, Maitra S, Gozi NK, Bhattacharjee S, Pal S, Sen S, Hazra AComparison between intrathecal isobaric ropivacaine-fentanyl and bupivacaine-fentanyl in elective infraumbilical orthopedic surgery: a randomized controlled study. J Anaesthesiol Clin Pharmacol. 2015;(4):542-6.