INTRATHECAL FENTANYL WITH SMALL-DOSE DILUTE BUPIVACAINE - BETTER ANESTHESIA WITHOUT PROLONGING RECOVERY

Recent concern regarding lidocaine neurotoxicity has prompted efforts to find alternatives to lidocaine spinal anesthesia. Small-dose dilute bupivacaine spinal anesthesia yields a comparably rapid recovery prof ile but may provide insufficient anesthesia. By exploiting the synergi sm between intrathecal opioids and local anesthetics, it may be possib le to augment the spinal anesthesia without prolonging recovery. Fifty patients undergoing ambulatory surgical arthroscopy were randomized i nto two groups receiving spinal anesthesia with 3 ml 0.17% bupivacaine in 2.66% dextrose without (Group I) or with (Group II) the addition o f 10 mu g fentanyl. Median block levels reached T7 and T8, respectivel y (P = not significant [NS]). Mean times to two-segment regression, S2 regression, time out of bed, time to urination, and time to discharge were 53 vs 67 min (P < 0.01), 120 vs 146 min (P < 0.05), 146 vs 163 m in (P = NS), 169 vs 177 min (P = NS), and 187 vs 195 min (P = NS) resp ectively. Motor blockade was similar between groups, but sensory block ade was significantly more intense in Group II (P < 0.01). Six of 25 b locks failed in Group I, whereas none failed in Group II. The addition of 10 mu g fentanyl to spinal anesthesia with dilute small-dose bupiv acaine intensifies and increases the duration of sensory blockade with out increasing the intensity of motor blockade or prolonging recovery to micturition or street fitness. Implications: Concerns about the neu rotoxicity of lidocaine have prompted efforts to find alternatives to lidocaine spinal anesthesia. We studied 50 patients undergoing ambulat ory surgical arthroscopy and found that although small-dose bupivacain e alone is inadequate for this procedure, the addition of fentanyl mak es it reliable.