Fast Track Surgery
Conditions
Brief summary
Background: In the context of day-case surgery, the optimal spinal anesthetic should give immediate and effective anesthesia for an appropriate period, followed by rapid regression of sensory and motor blocking, rapid bladder voiding, and little residual effects to allow for early ambulation and discharge. Although bupivacaine is safe and has a low rate of transient neurological symptoms (TNS), the prolonged sensory and motor block is a drawback for use in day-case spinal anesthesia. Similar to lidocaine, prilocaine is a local anesthetic with similar potency and duration of action and has been reported to have a lower incidence of TNS. Objective: To determine which local anesthetic, Prilocaine with added fentanyl versus bupivacaine with added fentanyl, is better in the setting of fast-track anesthesia in patients undergoing unilateral inguinal hernia. Material and methods: 70 Patients who were between 18-60 years old male patients, ASA grade I-II, BMI \< 35, undergoing elective unilateral inguinal hernia, standard surgical technique (open anterior prosthetic inguinal hernioplasty) inguinal hernia diagnosis is confirmed by ultrasonography, free medical history of micturition disorder, procedure lasting less than 90 minutes, having provided written informed consent signed by the patient or guardian were included. Those patients were divided into two groups. Group Pr (Prilocaine 40mg + fentanyl 25μ) and group Bu (Bupivacaine 7.5mg + fentanyl 25mcg)
Interventions
DRUGPrilocaine
Prilocaine 40mg (2ml) + fentanyl 25mcg in unilateral spinal anesthesia
DRUGBupivacain
Bupivacaine 7.5mg (1.5ml) + fentanyl 25mcg in unilateral spinal anesthesia
Sponsors
Theodor Bilharz Research Institute
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
DIAGNOSTIC
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
To compare unilateral intrathecal prilocaine versus bupivacaine with added fentanyl in both groups in inguinal hernia repair in the setting of fast-track anesthesia.
Eligibility
Sex/Gender
MALE
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
1. ASA I-II. 2. BMI \< 35 kg/m2. 3. Absence of micturition disorder. 4. Patients scheduled for elective unilateral inguinal hernia with standard surgical technique (open anterior prosthetic inguinal hernioplasty) with previous ultrasonography confirmation of the diagnosis.
Exclusion criteria
1. Allergic to any drug being used in the study. 2. ASA III-IV. 3. Suffering from bulky inguinal/inguino-scrotal hernias. 4. Patients with infection at the injection site. 5. Non-cooperative patients. 6. Patients having sensory or motor deficit in lower extremities or history of micturition disorder, abnormal coagulation profile, history of alcohol or substance abuse. 7. contraindications or failure of spinal anesthesia and surgery lasting more than 90 minutes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative voiding | first 2 hours postoperatively | time for the first spontaneous micturition |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| peak level of spinal anesthesia | 15 minutes | peak level of spinal anesthesia will be assessed by pinprick after 15 minutes from spinal anesthesia administration to determine the highest dermatome blocked. |
Countries
Egypt
Outcome results
None listed