Day
care varicose vein surgery is a critical surgical procedure that requires
careful attention to anesthesia protocols to optimize patient comfort and
safety. The selection between hyperbaric ropivacaine and its combination with
fentanyl should align with the surgical goals and patient preferences, as
patients often desire swift recovery and minimal postoperative complications.
The comparison of equipotent doses of hyperbaric 0.75percent ropivacaine alone
versus its combination with fentanyl stands out as a pivotal area of study.
Ropivacaine is a newer amino-amide local anesthetic (LA) agent similar to
bupivacaine in chemical structure but 30-40percent less potent. Intrathecal
ropivacaine is a safe and effective option for spinal anesthesia due to its
sensory-selective block and lower risk of motor blockade. The addition of
fentanyl to this local anesthetic introduces the potential for synergistic effects,
altering the pharmacodynamics of the anesthesia and potentially influencing
recovery parameters. Understanding how these regimens compare is essential for
optimizing anesthesia strategies and improving the overall surgical experience
for patients undergoing day care varicose vein procedures. The choice between
these two regimens requires careful consideration of multiple factors.
Equipotent doses play a crucial role, as achieving comparable analgesia with a
reduced total drug load may contribute to faster recovery and decreased side
effects. Additionally, patient-specific characteristics, such as age,
comorbidities, and pain sensitivity, influence the selection of the most
suitable anesthesia protocol. The balance between effective pain control and minimizing
adverse effects is paramount in the outpatient setting, where patients aim for
a swift return to normal activities. This study addresses the gap in existing
literature by providing a comprehensive examination of the comparative efficacy
and safety of hyperbaric 0.75percent ropivacaine alone versus its combination
with fentanyl in day care varicose vein surgery. Through an in-depth analysis
of equipotent doses, patient outcomes, and anesthesia-related parameters, this
research aims to contribute valuable insights that can inform evidence-based
practices and enhance the quality of care in this specific surgical context. Gupta
S et al (2024) evaluated the safety, efficacy, hemodynamic stability, and side
effects of spinal anesthesia using 0.5percent hyperbaric bupivacaine and 0.75percent
hyperbaric ropivacaine in patients undergoing transurethral resection of
prostate. The study found that hyperbaric ropivacaine exhibited significantly
slower onset times for sensory and motor blockade compared to hyperbaric
bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic
stability and experienced less hypotension compared to those who received
bupivacaine. Moreover, the sensory and motor block lasted significantly longer
in the bupivacaine group. About 0.75percent hyperbaric ropivacaine is a better
choice for spinal anesthesia in elderly patients undergoing TURP as compared to
0.5percent hyperbaric bupivacaine.
AIMS AND OBJECTIVES
Aims:
·
To assess and compare the analgesic efficacy of hyperbaric
0.75percent ropivacaine alone and in combination with fentanyl in day care
varicose vein surgery.
·
To evaluate recovery parameters, including time to
ambulation and discharge, between the two anesthesia regimens.
Objectives:
·
To study the effect, onset, sensory effect, motor effects of
both groups of patients
·
To analyze intraoperative parameters, such as sensory and
motor blockade.
·
To investigate postoperative pain intensity and time to
first analgesic request.
·
To assess the incidence of adverse effects, including
nausea, vomiting, and pruritus.
·
To compare patient satisfaction and overall recovery
experience with the two anesthesia approaches.
MATERIAL AND
METHODS
Study Settings: The study will be conducted in
Department of Anesthesiology, King George’s Medical University, Lucknow.
Study design: Prospective
randomized controlled study
Study duration: 2 years
Sample size:
Total 80 cases included in the study
40 in each group
Inclusion criteria:
·
Adult patients aged 18-80 years scheduled for day care varicose vein
surgery.
·
Patients giving written informed consent will be taken
Exclusion
criteria:
·
Patients with contraindications to spinal anesthesia or a history of
opioid sensitivity.
·
Patients not giving consent will not be included in the
study.
STUDY PROTOCOL
Ethical
clearance and Written and Informed consent will be taken. The study will be
done at King George Medical University,
Lucknow. All randomly allocate participants into two
groups:
Group A Hyperbaric 0.75percent ropivacaine
alone.
Group B Hyperbaric 0.75percent ropivacaine with
fentanyl.
Administer spinal anesthesia according to
group allocation. Standardize the technique, including patient positioning,
needle gauge, and injection speed. Record the exact dose administered in both
groups.
All patients baseline characteristics:
age, gender, BMI, and comorbidities. Monitor intraoperative parameters: blood
pressure, heart rate, and oxygen saturation. Assess sensory and motor blockade
using standardized scales at defined time intervals. Record intraoperative adverse events or
complications.
All patients evaluate postoperative pain
using validated pain scales VAS to be measure. Document time to first request
for analgesia. Monitor postoperative adverse effects, including nausea,
vomiting, and pruritus. Conduct short-term follow-up to assess any delayed
complications or adverse events.
Evaluate patient satisfaction with the
anesthesia technique.
Statistical
analysis
Statistical analysis was
performed by the SPSS version 23rd version. Continuous variables
were presented as mean SD and categorical variables were presented as absolute
numbers and percentage. Normally distributed continuous variables and
categorical variables were compared using appropriate statistical test. P value
less than 0.05 was taken as significant. |