title: Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study.
abstract: OBJECTIVE
  We studied the state entropy to monitor the sedative effect of subarachnoid block (SAB) using bupivacaine alone or combination of bupivacaine and fentanyl. The effect of use of fentanyl via the subarachnoid route on the sedation level was also studied using the entropy scores and the decrease in the requirement of propofol used as an adjuvant sedative drug.
  
  
  METHODS
  In this prospective randomized double-blind study, 30 patients of age 18-70 years requiring SAB were enrolled for the study. Patients with any known allergy to study drugs, contraindication for SAB, obesity, neurological or psychiatric disease on concurrent medication and refusal were excluded from the study. Patients were randomly allocated into two groups: Group C: SAB was administered with 2.5 mL (12.5 mg) of 0.5% hyperbaric bupivacaine; Group D: SAB was administered with 2.5 mL of 2 mL (10 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 μg) fentanyl. Propofol infusion was started if the state entropy (SE) value was ≥75, at the rate of 100 μg/kg/min till the SE value reaches in the range of 60-75 (recorded as onset time). Thereafter the infusion rate was titrated to maintain SE value between 60 and 75. The level of sedation was measured with SE and Ramsay sedation (RS) scale.
  
  
  RESULTS
  The demographic profile and baseline parameters, were comparable in two groups (P > 0.05). After SAB, decrease in SE and response entropy was noted in both the groups and fall was significant in Group D (P < 0.0001). The total propfol required in thew two groups were comparable being 3.97 ± 2.14 mg/kg in Group C and 3.41 ± 2.34 mg/kg in Group D (P = 0.342). The change in the mean RS values was from 1.17 ± 0.38 to 1.69 ± 0.47 in Group D (P = 0.06), whereas in Group C it was from 1.03 ± 0.18 to 1.43 ± 0.50 (P = 0.041) within 20 min of SAB.
  
  
  CONCLUSIONS
  Subarachnoid block causes sedation per se, but the level of sedation is not clinically significant and the sedation caused is not enough to avoid sedative agents for allaying anxiety in patients intraoperatively. The sedative effect of SAB was enhanced by adding intrathecal fentanyl probably because of better quality of SAB. SE showed good correlation with RS scaling system. Therefore, SE may be used as reliable tool to titrate sedation in patients undergoing surgery under SAB.
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prerna
authors.initials: P
authors.lastname: Varma
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vanlal
authors.initials: V
authors.lastname: Darlong
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Pandey
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Garg
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.lastname: Chandralekha
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Punj
keywords: Bupivacaine; fentanyl; sedation; state entropy; subarachnoid block