Prilocaine Fentanyl versus Bupivacaine-Fentanyl in Subarachnoid Anesthesia for Lower Abdominal Surgeries

Introduction and aim: Spinal anesthesia is a commonly and conveniently used for lower abdominal surgeries. The research on different drugs for spinal anesthesia is still ongoing to find out the standard and ideal drug. The current work aimed to compare efficacy and safety profile between prilocaine versus bupivacaine in spinal anesthesia for lower abdominal surgeries. Methodology: Ninety patients scheduled for elective lower abdominal surgeries were included and randomly assigned to one of two equal groups. All patients were preoperatively assessed by clinical and laboratory investigations. Hemodynamic monitoring was assessed intraoperatively every 5 minutes. Sensory and motor blockade and postoperative pain and time for first analgesic request were recorded.  The primary outcomes were efficacy of block (onset of sensory block, onset and intensity of motor block and duration of action). The Secondary outcomes were hemodynamic changes, post-operative analgesia, and patient satisfaction. Results: The time for the onset of the highest sensory block was shorter among P than B group (5.91±1.84 vs 8.26±1.98 minutes, respectively). Similarly, the time for the onset of the highest motor block level and PACU length of stay (minutes) was significantly shorter among P than B groups. The postoperative pain score was reduced in P than B group. The time for first analgesic request was shorter among P than B group (192.44±11.21 vs 235.77±29.44 minutes). Sensory regression to L1 was shorter among P than B groups. The motor regarrisons at one hour showed significant difference. The postoperative systolic blood pressure was significantly reduced in B than P group, with increased hypotension in B than P group (17.8% vs 4.4%, respectively). On the other side, no significant difference was observed for other complications or satisfaction score. Conclusion: The combination of prilocaine and fentanyl is superior than bupivacaine and fentanyl for subarachnoid anesthesia in lower abdominal surgery.