Open Access Open Access  Restricted Access Subscription Access

Comparative Study of Intrathecal Bupivacaine versus Bupivacaine With Fentanyl for Post-Operative Analgesia in an Elective Cesarean Section at a Tertiary Care Centre


Affiliations
1 Former PG Resident, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, India
2 Professor, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, India
 

Introduction: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. The finite duration of spinal anaesthesia is the only drawback as compared to general anaesthesia. Therefore combination of local anaesthetics with intrathecal opioids makes it possible to achieve prolonged post-operative analgesia without affecting the mother and the baby. Aims And Objectives: 1)To compare the effectiveness of plain bupivacaine with bupivacaine plus fentanyl for post -operative analgesia among the two groups. 2)To compare the adverse effects among both the groups. Materials and Methods: 154 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 9mg (1.8mL) of 0.5% hyperbaric bupivacaine plus 10 ug (0.2 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups, duration of effective analgesia and its effect on maternal and neonatal outcome was studied. Results: The duration of effective analgesia was significantly more in Group B +F (225.03+2.81)mins compared to Group B (119.90+2.76)mins. The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides effective and prolonged post-operative analgesia with less side effects.

Keywords

Bupivacaine, Cesarean Section, Fentanyl, Spinal Anaesthesia
Font Size

User
Notifications

  • Manoj Kumar N. Gajbhare, Neha P. Kamble,Comparative Study of Intrathecal Bupivacaine versus Bupivacaine with Fentanyl for Cesarean Section in 2016. Indian J ClinAnaesth. 2016;3(2):271–277. https://doi.org/10.5958/2394- 4994.2016.00049.4
  • Pollock JE, Neal JM, Stephenson CA, Wiley CE.Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anaesthesia. Anaesthesiology 1996;84:1361–1367. https://doi.org/10.1097/00000542- 199606000-00012
  • Tan PH, Chia YY, Lo Y, Yang LC, Lee TH. Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement. Can J Anesth. 2001;48(6):551–6. https://doi.org/10.1007/ BF03016831
  • Panchal S, Arria AM, Labhsetwar SA: Maternal mortality during hospital admission for delivery: Aretrospective analysis using a state-maintained database. Anesth Analg. 2001;93:134–141. https://doi.org/10.1097/00000539- 200107000-00028
  • Hawkins JL, Koonin LM, Palmer SK, et al: Anaesthesia related deaths during obstetric delivery in the united states, 1979-1990. Anesthesiology. 1999;86:277–284. https://doi. org/10.1097/00000542-199702000-00002
  • Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecalfentanyl and bupivacaine in spinal anaesthesia for caesarean section. BMC Anesthesiol. 2005;5:5. https:// doi.org/10.1186/1471-2253-5-5
  • Geetanjali T, Ajay K, Aruna J. Low dose intrathecal bupivacaine with fentanyl for caesarean delivery. JAnaesthClinPharmacol. 2008;24(1):201–204.
  • Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anaesthesiology. 1993;79;766– 73. https://doi.org/10.1097/00000542-199310000-00019
  • Agarwal A, Agarwal S, Asthana V, PayalYS.Comparison of intrathecalfentanyl and sufentanil inaddition to bupivacaine for caesarean section under spinal anaesthesia. J Anaesth Clin Pharmacol. 2009;25(2):154–56.
  • Dahlgren G, Hulstrand C, Jakobson J, Norman M. Intrthecalsufentanil, fentanyl or placebo added to bupivacaine for caesarean section. Anesth Analg. 1997;85:1288–93. https://doi.org/10.1097/00000539- 199712000-00020
  • Bano F, Sabbar S, Zafar S, Rafeeq N, et al. Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. JCPSP. 2005;16(2):87–90.
  • Seyedhejazi M, Madarek E. The effect of small dose bupivacaine – fentanyl in spinal anaesthesia on hemodynamic, nausea and vomiting in caesarean section. Pak J Med Sci. 2007;23(5):747–50.
  • Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective caesarean delivery during spinal anaesthesia. Reg Anaesth. 1992;17:126–30.
  • De Witte, Jan MD, Sessler. Perioperative shivering: physiology and pharmacology. Anaesthesiology. 2002;96,467–84. https://doi.org/10.1097/00000542- 200202000-00036
  • Techanivate A, Rodanant O, Somsiri T. Intrathecalfentanyl for prevention of shivering in caesarean section.J Med Assoc Thai. 2005;88:1214–21.
  • Szarvas S, Harmon D, Murphy d. Neuraxialopioidinducedpruritus: a review. J Clin Anesth. 2003;15(3):234-9. PMID:12770663. https://doi.org/10.1016/S0952-8180(02)00501-9
  • Belzarena S.D. Clinical effect of intrathecal administered fentanyl in patient undergoing caesarean section. Anaesth Analg. 1992;74:653–7. https://doi.org/10.1213/00000539- 199205000-00006

Abstract Views: 296

PDF Views: 85




  • Comparative Study of Intrathecal Bupivacaine versus Bupivacaine With Fentanyl for Post-Operative Analgesia in an Elective Cesarean Section at a Tertiary Care Centre

Abstract Views: 296  |  PDF Views: 85

Authors

Sunita Sankalecha
Former PG Resident, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, India
Neha Kishor Jaiswal
Professor, Department of Anaesthesiology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, India

Abstract


Introduction: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. The finite duration of spinal anaesthesia is the only drawback as compared to general anaesthesia. Therefore combination of local anaesthetics with intrathecal opioids makes it possible to achieve prolonged post-operative analgesia without affecting the mother and the baby. Aims And Objectives: 1)To compare the effectiveness of plain bupivacaine with bupivacaine plus fentanyl for post -operative analgesia among the two groups. 2)To compare the adverse effects among both the groups. Materials and Methods: 154 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 9mg (1.8mL) of 0.5% hyperbaric bupivacaine plus 10 ug (0.2 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups, duration of effective analgesia and its effect on maternal and neonatal outcome was studied. Results: The duration of effective analgesia was significantly more in Group B +F (225.03+2.81)mins compared to Group B (119.90+2.76)mins. The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides effective and prolonged post-operative analgesia with less side effects.

Keywords


Bupivacaine, Cesarean Section, Fentanyl, Spinal Anaesthesia

References





DOI: https://doi.org/10.18311/mvpjms%2F2020%2Fv7i2%2F24550