Comparison Between Intrathecal 0.5 Percent Isobaric Bupivacaine Hydrochloride Versus 0.5 Percent Hyperbaric Bupivacaine Hydrochloride With Fentanyl As An Adjuvant In Both For Proximal Femur Nailing Surgery A Prospective Randomized Double Blind Controlled Study

The primary aim of this study is to compare the efficacy of intrathecal  hyperbaric bupivacaine hydrochloride 2.5 ml with fentanyl 25mcg versus intrathecal isobaric bupivacaine hydrochloride 2.5 ml with fentanyl 25mcg for proximal femur nailing surgery

A  double blind randomized controlled clinical study will be conducted on 70 patients admitted at Pacific Medical college  Udaipur, over the period of two years. After obtaining the approval from the ethical committee of the institution, this study will be conducted. Informed written consent would be taken from patient and his/her relatives. Patients will be randomly divided into two groups using the closed envelope method. The study will include all patients aged between 50 and 70 years of either sex who belong to the American Society of Anesthesiologists ASA grade I or II are scheduled for proximal femoral nailing surgeries and require elective surgery only Group HB  – Total volume 3ml  Hyperbaric Bupivacaine  2.5ml  plus 0.5ml Fentanyl

Group IB  – Total volume 3ml Isobaric Bupivacaine 2.5ml  plus 0.5ml Fentanyl

To minimize bias in the level of block achieved with isobaric or hyperbaric bupivacaine a uniform total volume of 3 ml of the drug was administered slowly via the intrathecal route in both study groups.

On arrival in Operation Theatre, baseline blood pressure SBP DBP  MAP  heart rate  respiratory rate  and oxygen saturation  were checked before conducting the procedure The drug solution was prepared by another clinician who was not a part of the study Patient’s HR  RR  BP  and SpO2 were monitored continuously during the procedure

Spinal anesthesia would be done under all aseptic conditions with the necessary precautions, in L3-L4 or L4-L5 interspace in sitting position with 25G  Quincke needle via midline approach Patient will be immediately turned to supine and neutral position without any head-high or head-low so as to avoid bias. Blood pressure SBP DBP MAP heart rate  respiratory rate and oxygen saturation would be monitored at every 5 minutes for the first 30 minutes then every 30 minutes till the end of surgery

Sensory blockade was assessed by pin prick test  by using 22G hypodermic needle and Motor blockade was assessed by Modified Bromage scale

Postoperatively VAS score is measured at every 30 minutes until rescue analgesia is given Patient would be monitored for complications like hypotension nausea vomiting headache shivering urinary retention and bradycardia for 24 hours