Synergism between intrathecal fentanyl and l-bupivacaine in spinal anesthesia in geriatric patients

Introduction: Spinal anesthesia has a better postoperative outcome in elderly who have concurrent diseases. Conventional spinal anesthesia in the elderly is associated with high incidence of hypotension. The synergism between intrathecal fentanyl and low dose of local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension. Methods: Forty elderly ASA II-III patients, aged ≥ 70, years undergoing surgical repair of proximal femur fracture were randomized into two groups. The first study group received L-bupivacaine 9 mg and fentanyl 25 μg intrathecally (BF group) while the control group received levobupivacaine 15 mg only (B group). We were observed the quality of sensory and motor block, hemodynamic stability and side effects: respiratory depression, shivering, nausea and itching. Results: All patients had satisfactory anesthesia. The incidence of hypotension was more common in B group, nine patients and only two in BF group (p< 0, 05). The degree of motor block was significantly lower in in the BF group (p<0,01 ). Time of segmental regresion to L1 from maximal sensory level was significantly longer in the BF group ( 253 +/- 27,2. minutes) than 105,75 ± 12,06 minutes in the B group ( p < 0,001 ). Time of effective anal­gesia was significantly longer in the BF group (149 ± 9,12 minutes) than 157 ± 21,3 minutes in the B group p<0,001). The incidence of side effects was similar, except for a significantly higher of itching in the BF group (p< 0,01). Conclusion: The low dose of levobupivacaine with addition of intrathecaly fentanyl provide adequate spinal block, better hemodynamic stability with minimal side effects. .