Intrathecal Sufentanil, Fentanyl, or Placebo Added to Bupivacaine for Cesarean Section (original) (raw)
ANAESTHESIA, PAIN & INTENSIVE CARE, 2018
Aim: Present study was done to evaluate the influence of addition of sufentanil to bupivacaine 0.5% heavy, on various characteristics of subarachnoid block, when given to parturients. Methodology: The present prospective randomized clinical study of 60 patients was carried out in the Department of Anesthesiology, Government Medical College and SSG Hospital, Baroda. Spinal anesthesia was given in lumbar intervertebral space L3-L4, with midline approach, using 23 G spinal needle. Patients were randomly divided into two groups, to receive either inj bupivacaine heavy 0.5% (Group B) or inj bupivacaine heavy 0.5% plus 10 µg sufentanyl (Group BS). Various parameters monitored were vital parameters, sensory block, motor block, neonatal outcome, intra-operative complications, postoperative analgesia and postoperative complications. Results: The mean time for onset of sensory block was 78.46 ± 2.32 sec in Group B and 37.93 ± 1.39 sec in Group BS. The mean onset of motor block in Group B was 59.2 ± 2.76 sec while in Group BS it was 51.93 ± 1.48 sec. The difference was statistically significant. Patients in Group B were alert (grade 0) intra-operatively whereas majority of patients in Group BS had grade II sedation, denotes that they were sleepy but arousable. Conclusion: Addition of 1ml (10 µg) sufentanil to 2 ml of bupivacaine heavy (0.5%) intrathecally hastens the onset and prolongs the duration of sensory and motor blockade. Hemodynamic parameters are not affected with the inclusion of sufentanil. Citation: Jain N, Modh DB, Patel D. The effect of addition of intrathecal sufentanil to hyperbaric bupivacaine in cesarean section-a prospective randomized study.
International Journal of Research in Medical Sciences
Neuraxial block for lower segment cesarean section (LSCS) has become increasingly popular amongst parturients, as most of them prefer being awake during birth of the baby. 1 Many practitioners prefer spinal anaesthesia to epidural block because of simplicity of technique, rapidity in onset of action and reliability in producing uniform sensory and motor blockade as also avoiding the much dreaded complication of aspiration due to delayed gastric emptying as seen with general anaesthesia. 2-4 The disadvantages however are limited duration of action, lack of long lasting post-partum analgesia and visceral pain during manipulation of uterus or at the time of peritoneal closure associated with intra-operative nausea and vomiting. To overcome these problems, ABSTRACT Background: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 µg and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5% hyperbaric bupivacaine for caesarean section. Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under spinal anaesthesia in a randomized, prospective double blind comparative method in Lokmanya Tilak Municipal General Hospital after taking approval from hospital ethics committee. After fulfilling requirements of inclusion criteria patients were randomly divided into 2 groups of 30 each. Study group (BS) received intrathecal sufentanil 5 µg with 8 mg of 0.5% hyperbaric bupivacaine and the control group (B) received intrathecal 0.5% hyperbaric bupivacaine 10 mg. Pre, intra and postoperative investigations were made accordingly. Results: No significant differences were observed among demographic parameters like age, weight, height and duration of surgery (p>0.05). The results were statistically significant (p<0.05) when the two groups were compared for the sensory blockade and motor blockade and the time to first analgesic requirement was significantly (p<0.05) prolonged in group BS as compared to group B. Both the groups showed decrease in pulse rate as compared to the baseline in the intra-operative and postoperative period. A significant (p<0.05) fall in the systolic blood pressure in B group was observed compared to BS group from 4 min to 75. None of the patients in either group developed respiratory rate <10 per minute and fall in oxygen saturation throughout the observation period. The sedation scores of the both groups were comparable and are statistically significant (p<0.05) with each other. Conclusions: A reduced dose of 0.5% hyperbaric bupivacaine (8 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for cesarean section with better hemodynamic stability and low incidence of minor side effects as compared to 10 mg hyperbaric bupivacaine.
Anesthesiology and Pain Medicine
Background: Spinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics. Methods: This was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed. Results: There was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036). Conclusions: According to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.
Anesthesiology and Pain Medicine
Background: Decreasing side effects and improving the quality of block in caesarean sections by appropriate dosage of local anesthetics and adjuvants could play an important role in the safe management of cesarean section. The present study aimed at comparing the effects of 3 different doses of intrathecal hyperbaric bupivacaine injected with a fixed dose of sufentanil in cesarean sections. Methods: In a double-blind randomized clinical trial, 105 candidates of elective cesarean section were randomly assigned into 3 groups of 8, 9, and 10 mg of intrathecal bupivacaine plus sufentanil 2.5 µg. The maximum level of sensory block, the intensity of motor block, and vital signs were measured at regular intervals. The incidence of hypotension and bradycardia were also recorded. Results: No significant difference was found between the maximum level of sensory block and the intensity of motor block in 3 groups. The incidences of hypotension and bradycardia as well as administration of atropine and ephedrine were comparable among the 3 groups (P > 0.05). Conclusions: According to similar effects of different doses of bupivacaine, administration of lower doses of bupivacaine (8mg) is more reasonable for spinal anesthesia for cesarean section.
Comparative Study of Intrathecal Bupivacaine versus Bupivacaine with Fentanyl for Cesarean Section
Innovative publication, 2016
Background: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. Maternal hypotension following spinal anaesthesia remains common place in cesarean delivery. The combination of reduced dose of local anaesthetics with intrathecal opioids makes it possible to achieve adequate spinal anaesthesia with minimum hypotension. Objectives: The aim of our study was to compare the effectiveness of plain bupivacaine with low dose bupivacaine plus fentanyl with respect to sensory and motor blockade, hemodynamic changes, side effect profile and post-operative analgesia after spinal anaesthesia. Material and methods: 60 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 8mg (1.6 mL) of 0.5% hyperbaric bupivacaine plus 20 ug (0.4 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups and its effect on maternal and neonatal outcome was studied. Results: The mean time required to reach peak sensory level was earlier in Group B + F. Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly earlier in Group B. Duration of motor recovery was earlier in Group B +F. Mean maximal heart rate was significantly more in Group B. Mean minimal systolic arterial pressure was significantly less in Group B compared to Group B + F. The duration of effective analgesia was significantly more in Group B + F (235.33+29.15) compared to Group B (120.33+10.98). The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of low dose fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides satisfactory sensory and motor blockade, better hemodynamic stability, less side effects and effective post-operative analgesia.
IOSR Journals , 2019
Aim: The Aim of the study is to evaluate following factors when Levobupivacaine 0.5% 9mg + 10mcg Fentanyl and hyperbaric Bupivacaine 0.5% 9mg + 10mcg Fentanyl given intrathecally in elective caesarean section. Methodology:120 parturient with American Society of Anesthesiologists I-II undergoing elective caesarean section were enrolled for study with their informed consent. They were randomly divided equally to either Group BF receiving 1.8ml of 0.5% HyperbaricBupivacaine(9mg)+ 0.2ml Fentanyl(10mcg), or Group LF receiving 1.8ml of 0.5% IsobaricLevobupivacaine(9mg)+ 0.2ml Fentanyl(10mcg). Sensory and motor block characteristics of the groups were assessed with pinprick, cold swab, and Bromage scale; observed hemodynamic changes and side-effects were recorded. Effects on the neonate were observed by Modified Bromage Scale and umbilical cord blood gas analysis. Results: Hemodynamic parameters like mean arterial pressure of Group BF were found to be lower. Group BF exhibited maximum motor block level whereas in Group LF, max sensorial block level and postoperative visual analog scale scores were higher. Umbilical blood gas pCO 2 was slightly higher, and pO 2 was marginally lower in Group BF. Onset of motor block time, time to max motor block, time to T10 sensorial block, reversal of two dermatome, the first analgesic need were similar in both groups. Conclusion:plain Levobupivacaine 0.5% which is pure s-enantiomer of Bupivacaine is a good alternative for caesarean section in spinal anesthesia as it have less CVS and CNS toxicity when compared with Bupivacaine Hydrochloride. Early recovery of motor blockade leading to early mobilization of the mother and analgesia almost similar to racemic hyperbaric Bupivacaine. Addition of low dose Fentanyl 10mcg with Levobupivacaine has dose sparing effect of opiods on local anesthetics, better postoperative analgesia and early recovery from motor block. Action of isobaric Levobupivacaine is independent of gravity in spinal anesthesia.
International Journal of Medical Anesthesiology, 2020
Background: Various adjuvants have been used with local anaesthetics in spinal anaesthesia for lower segment caesarean section (LSCS) to provide better haemodynamics & prolonged postoperative analgesia. The aim of this study was to compare onset & duration of sensory & motor block with haemodynamic stability of intrathecal ketamine and fentanyl added to Bupivacaine in spinal anaesthesia for two different group of patients posted for LSCS Method: Sixty patients of age between 18-35 years and ASA grade I and II were included and randomly divided in to two groups of 30 each. Group K received injection bupivacaine 10 mg with 10 mg Ketamine and Group F received injection Bupivacaine 10 mg with 12.5 mcg Fentanyl. The sensorimotor characteristics, haemodynamic parameters, neonatal outcome and side effects were noted and compared between two groups. Results: Group K showed higher sensory level (<0.05), rapid sensory (P<0.05) and motor (P<0.05) onsets, prolonged sensory (P<0.05) and motor (P<0.05) blocks as compared to group F.Hyperbaric bupivacaine-Ketamine had better haemodynamic stability and significantly reduced incidence of hypotension (P<0.05) and bradycardia (P<0.05). Apgar scores at 1 and 5 min were comparable in both groups (P = 0.2734 and 0.6731 respectively).Tachycardia was found in 16.66% cases in group K, whereas no patient developed tachycardia in group F. Conclusion: The combination of hyperbaric bupivacaine (0.5%) 10mg with ketamine (10mg) can be used as a safe and effective alternative to hyperbaric bupivacaine (0.5%) 10mg with fentanyl 12.5mcg for spinal anaesthesia in LSCS.
Comparative Evaluation of Different Dose of Bupivacaine for Pain Control in Cesarean Section
Academia Anesthesiologica International, 2019
Background: Spinal anesthesia is the preferred choice of anesthesia for the conduct of emergency and elective cesarean section. Hypotension during spinal anesthesia for caesarean section continues to be a major problem. Aim: The present study investigated the safety and efficacy of 0.25% hyperbaric bupivacaine on the incidence of visceral pain during cesarean section performed under subarachnoid anesthesia. Subjects and Methods: Sixty patients who were scheduled for elective cesarean section, allocated randomly to one of three groups, according to patient`s height. Group 1, 2 and 3 received 3.2-3.6 mL (8-9 mg), 3.6-4.0 mL (9-10 mg) and 4.0-4.4 mL (10-11 mg) of 0.25% hyperbaric bupivacaine, respectively. Results: There was no difference in the incidence of visceral pain between three groups (p>0.05), but the quality of intraoperative analgesia, as needs for general anesthesia was significantly lower in group 3 than groups 1 and 2 (p<0.05). Conclusion: In conclusion, hyperbaric 0.25% bupivacaine in the dose of 10-11 mg is safe and effective in obtaining better quality of block in cesarean section, in order of reducing the severity of visceral pain.
There is no one ideal method of anesthesia for cesarean section, but epidural anesthesia is definitely one of the most popular technique used for cesarean section. Combining the epidural local anesthetic solution with opioids has become a common practice in obstetric anesthesia. The use of combination of local anesthetic solutions with opioids fastens the onset of surgical anesthesia; reduces the incidence of patchy anesthesia and improved analgesia. Fentanyl 50-100 µg or Sufentanil 10-20 µg are the opioids most commonly used to combine with local anesthetic solution used for epidural anesthetic. Aims and Objectives: 1. To compare the onset of surgical anesthesia and analgesia of epidural 0.5% bupivacaine with or without 50 µg of fentanyl. 2. To compare the intensity and quality of surgical anesthesia with I.V analgesics and /or N 2 O-O 2 by mask, of epidural blocks with 0.5% bupivacaine with or without 50µg of fentanyl. 3. To evaluate the newborn condition by Apgar score. 4. To study side effects and complication (if any) of addition of 50µg of fentanyl with 0.5% bupivacaine for epidural anesthesia for cesarean section.
2012
Pain free postoperative period and early ambulation are the need of the day for mothers caring for their neonates.The use of adjuvants in spinal analgesia has gained popularity in recent times. This prospective randomized study was carried out among 120 patients scheduled for elective caesarian section. They were divided into 4 groups. Group A (Control) received Injection Bupivacaine (Hyperbaric) along with 0.9% Normal saline, Group B, C and D received Clonidine 75 µg, Fentanyl 25 µg and Midazolam 2.5 mg along with injection Bupivacaine (H) respectively. The results of the present study showed that intrathecal Clonidine, Fentanyl and Midazolam can be used safely in parturient, provided strict protocol for preloading is followed by vigilant operative and post-operative monitoring by a trained person. Requirement of postoperative analgesics was found to be significantly reduced in all the study groups when compared with the control group. The highest duration of pain relief was found ...