2021, Vol. 4, Issue 3, Part B

Low-dose spinal saddle anaesthesia is a safe and reliable anaesthesia technique in outpatient perianal surgery, which provides a reliable but restricted block with good surgical conditions. Chloroprocaine was re-introduced without antioxidant and preservatives, which can be used safely in spinal anesthesia. Fentanyl is an opiod agonist, acts on mu receptor and of addition of fentanyl to chlorprocaine appears to lengthen the regression to L1 dermatome while minimally lengthening duration of block. This study was done to compare the effects of two different doses of fentanyl as an adjuvant to 1% Chloroprocaine under saddle block for perianal surgeries, and duration of stay in hospital.

Materials and Methods: The study was a randomized controlled double blinded trial conducted on 45 patients aged between 18 – 65 years (ASA 1 and 2) posted for perianal surgeries under spinal anaesthesia in private hospitals in and around Dakshina Kannada from January 2018 to June 2021. The groups are assigned as follows: Group A (n = 15) received1% Chloroprocaine 20 mg plus 0.5 ml of normal saline intrathecally. Group B (n = 15) received1% Chloroprocaine 20mg plus fentanyl 15 µg (0.3ml) + 0.2ml of normal saline intrathecally.

Group C (n = 15) received1% Chloroprocaine 20 mg plus fentanyl 25 µg (0.5ml) intrathecally. The sensory block, modified bromage scale, post operatively analgesia duration and the rescue analgesia patient’s and surgeon’s satisfaction score, side effects were noted.

Observations and Results: There was no significant difference in the maximum Bromage score for the motor block it was 11.57 seconds in Group and Group B and 11. 11.6 in group C . NRS score that denotes the quality of analgesia was higher in group A indicating that the satisfaction was lesser .In the group A the time was the longest followed by group B and group C had the least two segment sensory regression time and was statistically significant with a p value< 0.05. In our study in the group A the time for motor regression to baseline was the highest followed by group C and group B had the least time for the motor regression to baseline and was statistically significant with a p value < 0.05.group A required the highest number of analgesia doses followed by group B and group C required equal number of analgesia and was statistically significant with a p value < 0.05. Group A had the least patient and surgeon satisfaction scores followed by group B and group C had the maximum time and was statistically significant with a p value < 0.05.

Conclusion: Group B had better hemodynamic parameters than group A and group C . Group C was associated with a lot of adverse event intra op like hypotension and group A had a higher need of analgesic and faster sensory loss Hence, considering the nature and duration of the procedure, low dose saddle block anaesthesia with 2-Chloroprocaine would be a suitable choice and we evaluated the drug in varying doses to study the clinical response of varying doses, for procedures lasting for small duration 20 mg is sufficient, the addition of fentanyl may be adjusted based on the expected time of surgery.