A Clinical Prospective, Double Blinded Randomized Controlled Study to Compare the Intrathecal Hyperbaric Ropivacaine Hydrochloride 0.75% (3ml) plus Fentanyl with Intrathecal Hyperbaric Ropivacaine Hydrochloride 0.75% (3ml) plus Tramadol for Infraumbilical Surgeries

Background: Spinal anesthesia is preferred for infraumbilical surgeries due to its easier administration, reduced morbidity, effective postoperative analgesia and superior hemodynamic profile. This study compared the efficacy of intrathecal hyperbaric ropivacaine with fentanyl versus tramadol. METHODS: This prospective, randomized, double-blind study included 100 ASA I-II patients aged 20-60 years undergoing infraumbilical surgeries. Patients were randomly allocated into two groups: Group RF (n=50) received 3ml of 0.75% hyperbaric ropivacaine with 25µg fentanyl and Group RT (n=50) received 3ml of 0.75% hyperbaric ropivacaine with 25mg tramadol. Onset and duration of sensory and motor blockade, hemodynamic parameters, duration of analgesia, and adverse effects were compared. Results: Analysis of 100 patients revealed comparable demographic characteristics between groups. The onset of sensory block was statistically similar between Group RF (1.69±0.11 min) and Group RT (1.88±0.13 min, p>0.05), demonstrating equivalent initial anesthetic efficacy. However, the duration of sensory block was significantly prolonged in Group RF (396.30±25.57 min) compared to Group RT (316.30±25.97 min, p<0.01), representing an additional 80 minutes of effective sensory blockade. Motor block characteristics showed a similar pattern - comparable onset times between groups (RF: 2.52±0.28 min vs RT: 2.71±0.28 min, p>0.05), but significantly longer duration in Group RF (203.88±10.34 min vs 186.30±13.39 min, p<0.01). The duration of postoperative analgesia was markedly extended in Group RF (411.10±19.78 min) compared to Group RT (325.30±23.59 min, p<0.01), providing an additional 86 minutes of pain relief. Hemodynamic parameters including heart rate, blood pressure, and mean arterial pressure remained stable throughout the procedure in both groups, with no statistically significant differences. Visual Analogue Scale pain scores were significantly lower in Group RF at 4 hours (1.362±1.162 vs 2.931±1.927, p=0.013) and 8 hours (1.699±1.263 vs 3.821±1.924, p=0.022) postoperatively. The ropivacainefentanyl combination demonstrated a more favorable adverse effect profile, with lower incidence of bradycardia (6% vs 12%), hypotension (10% vs 18%), and complete absence of pruritis/shivering (0% vs 6%), though these differences did not reach statistical significance. Conclusion: Intrathecal hyperbaric ropivacaine with fentanyl provides superior postoperative analgesia, longer sensory and motor blockade, and fewer side effects compared to ropivacaine with tramadol for infraumbilical surgeries. [ABSTRACT FROM AUTHOR]