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Comparision of Bupivacaine alone and its Combination with Different Doses of Fentanyl in Spinal Anesthesia for Cesarean Section: a Prospective Randomized Study
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Background: Intrathecal administration of local anesthetics alone does not provide adequate analgesia during caesarian sections. The visceral pain associated with peritoneal traction can be obliterated by the addition of intrathecal opioid, due to their synergism.
Aims: The aim of this study was to observe the effect of intrathecal bupivacaine alone and in combination with fentanyl in two different doses.
Settings and Design: We performed a prospective randomized study on 90 consecutive patients undergoing caesarian section in our hospital.
Methods and Material: Ninety selected patients, who underwent cesarean section, of age ranging from 20-35 years, were randomized into three equal groups. Group I received hyperbaric bupivacaine (B) alone, where as group II and group III received hyperbaric bupivacaine along with 12.5 μg and 25 μg of fentanyl respectively (BFL&BFH). The quality and durations of analgesia was compared between the three groups. The effects of drug on neonate were monitored on the basis of Apgar score.
Statistical analysis: Unpaired't' test&'Z' test were used for statistical analysis.
Results: There were no differences in regard to Apgar scores between all three groups. The synergistic advantages were evident in both combination groups with respect to patient's comfort and ease of surgeons; but the maternal side effects were more in the group with higher dose of fentanyl (BFH). No adverse effect on neonates was observed in all three groups.
Conclusion: Since the clinical dose of spinal bupivacaine required to obliterate visceral pain causes undesirable side effects. Addition of fentanyl with bupivacaine, reduces the dose of local anesthetics in achieving adequate surgical anesthesia. We conclude that the combination of 12.5 μg of fentanyl along with 2ml of 0.5% hyperbaric bupivacaine achieved adequate anesthesia with minimal maternal and neonatal adverse effects.
Keywords
- Viscusi ER, Martin G, Hartrick CT, et al. Forty-eight hours of postoperative pain relief after total hip arthroplasty with a novel, extended-release epidural morphine formulation. Anesthesiology 2005;102(5):1014-22.
- Marino J, Russo J, Kenny M, Herenstein R, Livote E, Chelly JE. Continuous lumbar plexus block for postoperative pain control after total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am 2009;91(1):29-37.
- Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: results from an overview of randomised trials.Br Med J 2000;321:1493.
- Cooper D W, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS.Fetal and Maternal Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery. Anesthesiology2002; 97(6):1582-1590.
- Liu SS, McDonald SB, Susan B.Current Issues in Spinal Anesthesia. Anesthesiology 2001; 94(5): 888-906.
- Musaid RA,Naranjo TM. Spinal block complications in obstetrics and gynaecology patients. Neurosciences 2006;11(3):140-144.
- Dyer RA, James M F.Low-dose versus a Higherdose Bupivacaine Spinal Anesthesia for Cesarean Delivery. Anesthesiology 2009;111(1): 215-216.
- Huei MY, Li KC,Ming KS, Chen JL, Wei ZS, Ming JW, Martin SM, Shen KT. The Addition of Morphine Prolongs Fentanyl-Bupivacaine Spinal Analgesia for the Relief of Labor Pain. Anesth Analg 2001; 92(3):665-668.
- Sarvela J, Halonen P, Soikkeli A, Korttila K. A double-blinded,randomized comparision of intrathecal and epidural morphine for elective cesarean delivery. Anesth Analg 2002; 95:436-440.
- Gadsden J, Hart S, Santos AC. Post- cesarean delivery Analgesia. Anesth Analg 2005; 101(5S):562-569.
- Arai YC,Ogata J, Fukunaga K, Shimazu A, Fujioka A, Uchida T. The effect of intrathecal fentanyl added to hyperbaric bupivacaine on maternal respiratory function during cesarean section. Acta Anaesthesiol Scand 2006;50(3):364-7.
- Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE et al. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg 2002; 95:209-213.
- Carvalho B. Respiratory depression after neuraxial opioids in the obstetric setting. Anesth Analg 2008; 107(3):956-961.
- Harsoor SS,Vikram MSSpinal anesthesia with low dose bupivacaine with fentanyl for caesarean section SAARC J. Anaesth. 2008; 1(2) : 142-145.
- Hindle A. Intrathecal opioids in the management of acute postoperative pain. Contin Educ Anaesth Crit Care Pain2008; 8 (3): 81-85.
- Siti SG,Choy YC.Comparison of morphine with fentanyl added to intrathecal 0.5% hyperbaric bupivacaine for analgesia after caesarean section.Med J Malaysia, 2009 Mar;64(1):71-4.
- Choi DH, Ahn HJ, Kim MH: Bupivacaine sparing effect of fentanyl in spinal anesthesia for caesarean delivery. Reg Anaesth and Pain Medicine 2000: 25,240-245.
- Singh H, Yang J, Thornton K, Giesecke AH. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anesth 1995 , 42:987-91.
- Biswas R B,Rudra A,Bose BK,Nath S, et al. Intrathecal fentanyl with bupivacaine for intraoperative & postoperative analgesia.Indian J. Anaesth. 2002; 46 (6): 469-472 469.
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