A comparative study Of intrathecal (0.75%) Ropivacaine and (0.75%) Ropivacaine with Fentanyl in daycare perianal surgeries.

Subarachnoid block (SAB) is most widely used regional anesthesia technique in the world. It is a reliable, quick, effective and safe technique with predictable benefits, and has been the procedure of choice for perianal surgeries unless contraindicated.  The changing trend of surgical practice from an inpatient to outpatient has urged us to use short duration acting local anesthetic.

An ideal anesthetic for spinal anesthesia in ambulatory

surgery should provide rapid onset, adequate potency, predictable duration, decreased neurotoxicity along with minimal systemic side effects.The evidence for transient neurological symptoms (TNS) associated with the short-acting spinal anesthetic lidocaine has led to the use of alternative drugs such as bupivacaine, levobupivacaine or ropivacaine. Ropivacaine is the pure S enantiomer of propivacaine and is a amide local anaesthetic which is associated with a lower grade of motor block, a shorter duration of action than bupivacaine and a reduced potential for CNS and cardiac toxicity, making it a possible alternative to lidocaine for shorter outpatient procedures.

The dose of local anesthetic  can be reduced by the addition of adjuvant like opioids and alpha 2 adrenergic agonists.

Subarachnoid fentanyl is known to provide rapid onset of analgesia, improve surgical blockade quality and enhance the effect of small doses of subarachnoid local anaesthetic.

We hypothesise that addition of fentanyl to ropivacaine as neuraxial adjuvant improves the quality of spinal block and prolongs postoperative analgesia without significantly prolonging the time for ambulation without assistance.