Efficacy and Safety of Fentanyl as An Adjuvant To 0.75% Isobaric Ropivacaine in Epidural Anaesthesia for Infraumbilical Surgeries

Abstract

Background: Epidural anaesthesia with ropivacaine is commonly employed for infraumbilical surgeries. The addition of fentanyl as an adjuvant aims to enhance analgesic efficacy, but a comprehensive assessment of its effects on sensory and motor blockade, hemodynamic stability, and safety is warranted.

Objectives: This randomized controlled trial aimed to compare the efficacy and safety of 0.75% isobaric ropivacaine alone versus 0.75% isobaric ropivacaine with fentanyl in epidural anaesthesia for infraumbilical surgeries.

Methods: Sixty adult patients undergoing elective infraumbilical surgeries were randomly assigned to receive either 0.75% isobaric ropivacaine (Group R) or 0.75% isobaric ropivacaine with 50 mcg fentanyl (Group RF) epidurally. Sensory and motor blockade characteristics, including onset, duration, and two-segment regression, were recorded. Hemodynamic parameters (systolic, diastolic, and mean arterial pressures, and heart rate) were monitored at regular intervals. Perioperative sedation and postoperative analgesic effect were assessed. Perioperative and postoperative complications were documented.

Results: Baseline demographic and clinical characteristics were comparable between the two groups. Group RF exhibited a significantly shorter time to two-segment regression of sensory level (59.2 ± 5.1 min vs. 67.3 ± 7.4 min, p=0.02) and a shorter time to reach the highest sensory blockade (19.1 ± 1.8 min vs. 22.1 ± 1.3 min, p=0.01). The duration of sensory and motor block was similar between both groups (p>0.05). Hemodynamic parameters in Group RF showed an initial transient decrease in blood pressure, followed by stabilization, and an initial increase in heart rate, followed by a decrease at later time points. The incidence of bradycardia and hypotension was low and comparable between the groups (p>0.05).

Conclusions: The addition of 50 mcg fentanyl to 0.75% isobaric ropivacaine in epidural anaesthesia for infraumbilical surgeries significantly accelerates the onset and progression of sensory blockade without prolonging its duration. Fentanyl induces transient hemodynamic changes that are clinically manageable. The combination is safe and effective for providing surgical anaesthesia.