ABSTRACT
Background: Maintenance of the body physiology as near normal as possible during spinal anesthesia is one of the primary goals of the anaesthesiologist. As we know, marked hemodynamic derangements are often seen following subarachnoid block especially in trauma and elderly patients. Neuraxial opioids are not associated with sympathetic nervous system denervation, skeletal muscle weakness or loss of propioception. They predominantly act at the μ receptors present in the substantia gelatinosa of the spinal cord to exert its synergistic analgesic effect more specifically for visceral pain. . Studies have established that opioids and local anesthetics administered together intrathecally have a potent synergistic analgesic effect. Objectives This study was conducted for evaluate the efficacy of low dose hyperbaric bupivacaine plus fentanyl for spinal anaesthesia in the elderly and study the incidence of hypotension in the compared groups.1 Methods: This was prospective study carried out on 60 patient posted for elective lower limb orthopedic surgeries during the period 2010-2011 at civil hospital gandhinagar.The study population was randomly allocated to two groups; Group A - 15mg of 0.5% bupivacaine & Group B - 10mg of 0.5% bupivacaine and 25μg of fentanyl. Results: After analyzing the results of our study we find that systolic B.P. decreased in both the groups, maximum fall occurredat 15 to 20 min in both the groups: decreases were more severe in group A than in group B,(P<0.O5).heart rates were better maintained in group B than in group A. thus group B showed better hemodynamic stability. group b had lesser duration of motor blockage without significantly compromising the duration of sensory block or the operative conditions. none of the patients required intraop anesthetic supplementation. 3 patients in group B had pruritus while none of the patients developed respiratory depression. Conclusion: subarachnoid block with 2cc bupivacaine 0.5% and 25μg fentanyl is a safer and better option, both in terms of maintaining hemodynamic stability and lower incidence of complications without compromising the surgical conditions, for elderly patients undergoing lower limb surgeries.