Background and Aims Thoracic continuous spinal anaesthesia (T-CSA) is emerging as a sole anaesthetic for major abdominal surgeries due to its better perioperative outcomes. The present study is designed to evaluate block characteristics and outcomes in opioid-based (Bupivacaine with Fentanyl-group BF) versus opioid-free (Bupivacaine alone- group B), T-CSA for major abdominal surgeries in a doubled blinded randomized control trial.

Methods Patients were randomized into B and BF groups. The outcomes measured were peri-operative rescue opioid requirement, opioid-related side effects, dose of bupivacaine required to achieve T4 level, pain scores, conversion to general anaesthesia, hemodynamic stability, patient and surgeon satisfactions, gut motility, length of hospital stays, in-hospital morbidity and mortality

Results A total of 50 patients underwent T-CSA technique, 25 in each group. The opioid based group performed significantly better compared to bupivacaine alone group with respect to decreased intrathecal bupivacaine requirement [induction (p=0.012) and maintenance (p=0.031)], post-operative rescue fentanyl requirement (p=0.018), pain scores at rest at 0, 18, 24 hours and patient satisfaction (p =0.032) at the cost of increased post- operative nausea and vomiting (PONV)

Conclusions Opioid based T-CSA reduced postoperative rescue analgesia requirement, improved patient satisfaction and better postoperative analgesia with manageable PONV when compared with bupivacaine alone group. But both groups, provided equal surgical anaesthesia conditions. We did not observe single morbidity, re-exploration, re-admission and in hospital mortality in any of groups. However, more studies with the larger sample size and different optimal combinations of drugs are required to establish the role of CTSA in major abdominal surgery.