FRONTIERS IN MEDICAL CASE REPORTS - Volume 6; Issue 3, (May-June, 2025)

Pages: 01-02

Date of Publication: 14-May-2025

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Spinal Fortwin in A Patient with A Full-Blow Septic Shock- Still A Valuable Option in Severe Sepsis: A Scoping Review

Author: Nivetha S, Jagan Govindasamy, Dhinesh Kumar C, Krishna Prasad T

Category: Medical Case Reports

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Intrathecal opioids are commonly used to treat acute pain, either by themselves or in conjunction with other drugs. Motor paralysis following surgery below the umbilicus and extended post-operative analgesia has been shown to benefit from intrathecal pentazocine's adequate analgesia and motor blockage. Following six hours of NPO, patients were preloaded in an odd ratio using 15 ml/kg of body weight of Ringer's lactate solution. The supine position was applied to the patient right away. During the operation, none of the patients received sedation or analgesia.

After the intrathecal injection, the degree of sensory block was attained by monitoring the onset of sensory analgesia. The length of time that analgesia was from the moment the sensory level was reached until the two dermatomes underwent regression or the onset of alternate analgesia modes. For the first six hours and then every twelve hours after surgery, pain was measured every six hours to determine the total amount of time that post-operative analgesia lasted. We assessed the level of motor blockage using the Bromage scale. The motor blockade's length was determined by comparing grade 4 power to grade 1 power, if intravenous fluids are ineffective, in a dosage of 3–6 mg.

Opioids are an effective way to deliver enough anaesthesia for surgery with no hemodynamic instability when administered intrathecally as the only anaesthetic. Additionally, it offers sufficient pain relief following surgery. All of the effects of subarachnoid local anaesthetic injection, including sympathetic, motor, and sensory blocking, are exhibited by intrathecal pentazocine. In the current investigation, the highest degree of sensory blockage fluctuated around T11 and T8. The reduced rostral distribution of pentazocine in CSF due to its increased lipid solubility may be the source of a greater sensory block in the local anaesthetic group. The two groups' durations of surgical anaesthesia did not differ significantly. Compared to intrathecal bupivacaine, intrathecal pentazocine caused analgesia that lasted noticeably longer.

Despite the faster two dermatomal regression of sensory block, the pentazocine group required a significantly longer time for the initial rescue analgesia than the bupivacaine group. This was another intriguing finding noted in other studies (Swaraj et al., 1988; Donadoni et al., 1988)

This might be as a result of subarachnoid opioids' longer duration of effect as compared to intrathecal local anaesthetics. Because of the higher sympathetic blockage caused by the local anaesthetic, Group B's MAP was much lower at 1, 3, and 5 minutes. However, there was no significant difference in the MAP at 10 and 15 minutes across the groups, which might be because group B received intravenous fluids or vasopressors to address their hypotension.

The group's MAP was significantly lower at 30, 45, and 60 minutes, which may have been due to the local anaesthetic's extended hypotension. The slight variation in MAP between the two groups by 90 to 120 minutes may be due to the intravascular volume being increased by intraoperative IV fluids and the vasodilation brought on by sympathetic blockade beginning to wean off. With the extra benefit of longer post-operative analgesia, the hemodynamic stability after intrathecal pentazocine may be beneficial in elderly patients with hypovolemia and coronary artery disease, as well as high-risk patients (Nair et al., 2013).

For lower limb procedures, intrathecal pentazocine is the recommended anaesthetic drug due to its sufficient surgical anaesthesia, intraoperative hemodynamic stability, and extended post-operative analgesia.

References:

Donadoni R, Rolly G, Devulder J, Verdonck R. Double-blind comparison between nalbuphine and pentazocine in the control of postoperative pain after orthopaedic surgery. Acta Anaesthesiol Belg 1988; 39: 251-256.

Nair J, Rajan S, Paul J, Andrews S. Efficacy and safety of intrathecal pentazocine as a sole anaesthetic agent for lower limb surgeries. Anesth Essays Res 2013; 7: 49-53.

Swaraj, Saxena R, Sabzposh SW, Shakoor A. Effect on intrathecal pentazocine on postoperative pain relief. J Indian Med Assoc 1988; 86: 93-96.