ĐÁNH GIÁ HIỆU QUẢ GÂY TÊ TUỶ SỐNG BẰNG BUPIVACAIN PHỐI HỢP SUFENTANIL TRONG PHẪU THUẬT NỘI SOI KHỚP GỐI

Việt Trần Quốc; Trâm Nguyễn Thị Hồng; Nga Nguyễn Phương

doi:10.59354/ydth175.2023.212

Keywords:

Spinal anesthesia, knee endoscopy, bupivacaine, sufentanil

Abstract

Objective: To compare the effectiveness of spinal anesthesia using bupivacaine combined with sufentanil and bupivacaine combined with fentanyl and evaluate the adverse effects of the bupivacaine-sufentanil mixture, particularly in endoscopy procedures.

Subjects: Eighty patients underwent laparoscopic surgery under live anesthesia at Tam Anh General Hospital in Ho Chi Minh City from February to August 2022. They were divided into two groups, each consisting of 40 patients. Group I (BS group) received spinal anesthesia with 10mg bupivacaine at 0.5% concentration combined with 5mcg sufentanil. Group II (Group BF) received spinal anesthesia with 10mg bupivacaine at 0.5% concentration combined with 20mcg fentanyl.

Methods: Cross-sectional descriptive study with control group.

Results: - Anesthesia effect of spinal anesthesia with bupivacaine combined with sufentanil: + T12 sensory inhibition latency time in the group using bupivacaine combined with sufentanil was 3.15 ± 1.00 minutes, which was slower than the group using fentanyl, which was 4.50 ± 1.77 minutes (p < 0.001). + Pain relief time and post-operative pain relief time in the group using bupivacaine combined with sufentanil were higher than the group using fentanyl (p < 0.001). + The highest level of pain inhibition after 15 minutes of spinal anesthesia in the two groups was at the T10 level, with a rate of 42.5% in the bupivacaine-sufentanil group and 45% in the fentanyl group (p > 0.05). + VAS scores at rest and during exercise at 3, 6, 9, and 24 hours after surgery in the group using bupivacaine combined with sufentanil were lower than the group using fentanyl (p < 0.01).

Motor inhibition effect of spinal anesthesia with bupivacaine combined with sufentanil: + M1 motor mode latency time and complete motor recovery time in the group using bupivacaine combined with sufentanil were lower than the group using fentanyl (p < 0.001). + The level of motor inhibition after 15 minutes of spinal anesthesia in the group using bupivacaine combined with sufentanil was at M2 level of 50% and M3 at 50%, while the group using fentanyl was mainly at M3 level with a rate of 70% (p > 0.05). + The level of motor inhibition at the end of the surgery in the group using bupivacaine combined with sufentanil was at M0 in 5%, M1 in 55%, M2 in 20%, M3 in 20%, whereas in the high-intensity fentanyl combination group, the operating mode in M1 was 17.5%, M2 was 42.5%, M3 was 40%. There were statistically significant differences (p < 0.01).

- Adverse effects of spinal anesthesia with bupivacaine combined with sufentanil: The rate of patients with hypotension, nausea, or rigors was 2.5% in the group using bupivacaine combined with sufentanil, while the group using fentanyl combined had 2.5% of patients with bradycardia. The adverse effects between the two groups were not statistically significant (p > 0.05).

Conclusion: Spinal anesthesia with bupivacaine combined with sufentanil for knee arthroscopic surgery is more effective in terms of anesthesia and motor inhibition compared to bupivacaine combined with fentanyl. The rate of patients experiencing adverse effects was low, and there was no significant difference between the two groups.

References

Katz, J.N., S.A. Brownlee, and M.H. Jones, The role of arthroscopy in the management of knee osteoarthritis. Best Pract Res Clin Rheumatol, 2014. 28(1): p. 143-56.

Cousins, M.J. and L.E. Mather, Intrathecal and epidural administration of opioids. Anesthesiology, 1984. 61(3): p. 276-310.

Akerman, B., E. Arweström, and C. Post, Local anesthetics potentiate spinal morphine antinociception. Anesth Analg, 1988. 67(10): p. 943-8.

Abouleish, E., et al., Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg, 1988. 67(4): p. 370-4.

Bromage, P.R., A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand Suppl, 1965. 16: p. 55- 69

Aydın, F., et al., Comparison of bupivacaine alone and in combination with sufentanil in patients undergoing arthroscopic knee surgery. Knee Surg Sports Traumatol Arthrosc, 2011. 19(11): p. 1915-9.

Krobot, R., Unilateral bupivacaine-fentanyl or bupivacaine-sufentanil spinal anaesthesia for arthroscopic knee surgery. PERIODICUM BIOLOGORUM VOL. 113, No 2, 235–238, 2011, 2011.

Hassani, V., et al., Bupivacaine- Sufentanil Versus Bupivacaine-Fentanyl in Spinal Anesthesia of Patients Undergoing Lower Extremity Surgery. Anesthesiology and pain medicine, 2014. 4: p. e12091.