Comparative Efficacy of Intrathecal Pethidine with Lignocaine 5% (Heavy) as Sole Anaesthetic Agent for Perineal Operations

Intrathecal Pethidine with Lignocaine 5% (Heavy) as Sole Anaesthetic Agent for Perineal Operations

Abstract

Background: The discovery of opioid receptors and ligand in the brain and spinal cord lead to the feasibility of their use intrathecally. Pethidine is the only narcotic that has been shown to be effective intrathecally for surgery. This is probably because it as a phenyl-piperidine derivative and has a structure and action similar to that of local anaesthetic.Subjects and Methods:50 patients belonging to ASA grade 1 and 2 physical status were randomly assigned to two groups A and B. Patients in group A received 1 ml of 5% lignocaine (heavy) intrathecally and those in group B gained intrathecal Pethidine (preservative-free) 0.5mg/kg body weight. The time for onset and level of sensory blockade, onset and degree of motor blockade, hemodynamic parameters, time for regression of sensory and motor blockade, duration of postoperative analgesia and side effects were noted and compared in both the groups.Results:Two groups were comparable with respect to age, sex, height and weight. The onset of sensory and motor blockade in-group A was 2.001.06min and 2.560.88 and in-group B it was 3.561.64 min and 7.221.11 min respectively, which was statistically significant. Grade I motor paralysis was seen in 2 cases (10%) in group A and 15 cases (75%) in groupB. Grade II motor paralysis was seen in 6 cases (30%) in group A and 5 cases (25%) in group B. Grade III motor paralysis was viewed in 12 cases (60%) in group A and 0 cases(0%) in group B. Grade I and III motor paralysis in the groups were statistically significant (p<0.05). Time for sensory regression at L1 was 65.124.83 min in-group A and 94.606.88 min in-group B that was statistically very significant (p<0.05). The time for regression of motor blockade was 60.403.85 in-group A and 60.205.02 in group B, which was statistically not significant (p>0.05). The duration of postoperative analgesia was 122.849.37 min in-group A and 320.6023.02 in group B, which was statistically very significant. The incidence of side effects was comparable in both groups.Conclusion:Pethidine (preservative-free) 0.5mg/kg body weight can be used intrathecally as a sole anaesthetic agent to provide prolonged postoperative analgesia associated with hemodynamic stability and early ambulation in patients undergoing perineal surgeries.