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IMMEDIATE POSTOPERATIVE COMPLICATIONS AND RECOVERY PROFILE FOLLOWING SPINAL ANAESTHESIA: A COMPARISON BETWEEN PETHIDINE AND BUPIVACAINE
Abstract
BACKGROUND: In a resource poor environment, where there is scarcity of medical gases and specialist anaesthetists, spinal anaesthesia is a cheaper alternative to general anaesthesia for surgical procedures below the umbilicus. With spinal anaesthesia the patient’s airway is not compromised and numerous other advantages also accrue to both the patient and the physician. Bupivacaine is commonly used for spinal anaesthesia following the withdrawal of hyperbaric lidocaine for causing radiculopathy when injected intrathecally. Pethidine, a lipophilic opioid with local anaesthetic activity is used for spinal. This study seeks to compare the immediate postoperative complications and recovery profile following spinal anaesthesia with pethidine and bupivacaine as sole agents. METHOD: Fifty two American Society of Anesthesiologists physical status I and II patients, aged between 18 and 60 years, were randomized to receive spinal anaesthesia for short surgical procedures of the lower body. The patients were either given preservative-free pethidine 1mg/Kg (n=26) or 2.5mL isobaric 0.5% bupivacaine (n=26), and the time to recovery of pinprick sensation at S2, plantar flexion, proprioception of the big toe, and full motor recovery (Bromage score 0), were compared. Complications of pain, sedation, nausea and vomiting, pruritus and urinary retention in the immediate postoperative period were compared. RESULTS: When pethidine was compared with bupivacaine, the time to return of pinprick sensation at S2 was 94.62±20.25 minutes and 205.96±31.05 minutes respectively. The time to return of plantar flexion between pethidine and bupivacaine was 92.88±12.01 minutes and
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193.85± 39.56 minutes respectively. The mean time to recovery of proprioception of the big toe between pethidine and bupivacaine 31.15±9.41 minutes and 172.50±42.70 minutes respectively. The time it took for complete motor recovery (Bromage score 0), between pethidine and Bupivacaine, was 47.89±14.08 minutes and 221.73±44.72 minutes respectively. All the differences in recovery times were significant (p<0.0001). In the immediate postoperative period there was no significant difference in the incidence of pain and sedation. Four patients (15.38%) in the Bupivacaine group experienced mild and tolerable pain. There was no incidence of nausea and vomiting in either group. However, five patients (19.22%) in the pethidine group experienced pruritus, while bupivacaine group recorded none (0.00%). The difference was significant (p=0.020). Three patients (11.54%) in the Bupivacaine group also had urinary retention, while pethidine group had none (0.00%). This difference in incidence of urinary retention was significant (p = 0.048). CONCLUSION: Pethidine exhibited a shorter recovery profile than bupivacaine and also caused no significant complication in the immediate postoperative period.
