Intrathecal Sufentanil, Fentanyl, or Placebo Added to Bupivacaine for Cesarean Section (original) (raw)
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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.
Acta medica Iranica, 2016
Pain management is crucially important in the postoperative period as it increases patient comfort and satisfaction. The primary outcome of present study was to evaluate the effect of sufentanil added to hyperbaric bupivacaine solution 0.25% in transversus abdominis plane (TAP) block, on postoperative analgesic consumption. Fifty ASA physical status I-II term primiparous single-tone pregnant women aged 20-40 years scheduled for elective cesarean delivery with Pfannenstiel incision under general anaesthesia were enrolled in this randomized, double-blind, placebo-controlled trial. Ultrasound guided TAP block was performed at the end of surgery. Patients were randomly enrolled into two groups. Patients in the study group received 20 ml of hyperbaric bupivacaine 0.25% plus 1mL of sufentanil on either side while patients in the placebo group were administered 20 ml of hyperbaric bupivacaine 0.25% along with 1mL of placebo. Post-cesarean delivery visual analogue scale (VAS) for pain and m...
Anesthesia & Analgesia, 2002
Forty-eight healthy parturients scheduled for elective cesarean delivery were randomly allocated to receive intrathecally either 12 mg of hyperbaric bupivacaine plus 12.5 g of fentanyl (n ϭ 23) or bupivacaine alone (n ϭ 25). In the latter group, IV 12.5 g of fentanyl was administered immediately after spinal anesthesia. We compared the amount of IV fentanyl required for supplementation of the spinal anesthesia during surgery, the intraoperative visual analog scale, the time to the first request for postoperative analgesia, and the incidence of adverse effects. Additional IV fentanyl supplementation amounting to a mean of 32 Ϯ 35 g was required in the IV Fentanyl group, whereas no supple-mentation was required in the Intrathecal Fentanyl group (P ϭ 0.009). The time to the first request for postoperative analgesia was significantly longer in the Intrathecal Fentanyl group than in the IV Fentanyl group (159 Ϯ 39 min versus 119 Ϯ 44 min; P ϭ 0.003). The incidence of systolic blood pressure Ͻ90 mm Hg and the ephedrine requirements were significantly higher in the IV Fentanyl group as compared with the Intrathecal Fentanyl group (P ϭ 0.01). Also, intraoperative nausea and vomiting occurred less frequently in the Intrathecal Fentanyl group compared with the IV Fentanyl group (8 of 23 vs 17 of 25; P ϭ 0.02).
Comparative Study of Effect of Low Dose Intrathecal Bupivacaine with Fentanyl for Caesarean Delivery
IOSR Journals , 2019
Many drug combinations have been used to improve the quality of subarachnoid block during caesarean section. The synergistic effect of combining local anaesthetic with opioid intrathecally has numerous advantages. Amongst the opioids, Fentanyl addition has been suggested to have various benefits and this has proved in various studies. Hence, this prospective and randomized double blind study was undertaken to compare the efficacy and safety of two different intrathecal fentanyl doses with hyperbaric bupivacaine in terms of the quality and intensity of subarachnoid block in patients undergoing elective caesarean sections. METHODS-100 healthy parturients, scheduled for elective caesarean section with singleton pregnancy were allocated randomly into two groups, 50 in each group. Group I received intrathecal 0.5% Bupivacaine Heavy 1.8 ml with Fentanyl 10ug (0.2 ml) with 0.2 ml saline. Group II was given Intrathecal 0.5% Bupivacaine Heavy 1.8 ml with Fentanyl 20 ug (0.4ml). Total volume of both solutions was 2.2 ml. During the study, cardiorespiratory parameters, time required to achieve highest sensory block to T4-T6 level, duration of anaesthesia, onset and total duration of motor blockade, intraoperative analgesic supplementation, postoperative pain relief, vasopressor requirement, duration of effective analgesia, maternal and neonatal side effects were monitored. RESULTS-The duration of anaesthesia and effective analgesia was significantly prolonged in Group II as compared to group I. Onset and duration of complete motor blockade in both groups were similar. Subjective pain score was lowest in Group II than Group I. The duration of analgesia assessed by visual analogue scale was significantly more in Group II with a mean effective analgesia time of 289.60±11.75 minutes than Group I of 146.06±8.75 minutes. The incidence of maternal side effects and neonatal outcome were comparable in both groups. CONCLUSION-Addition of fentanyl 20ug as compared to 10 ug to intrathecal hyperbaric bupivacaine in caesarean section markedly enhances quality of surgical anaesthesia, prolonged duration of sensory block and effective analgesia, without affecting maternal and fetal well-being.
Journal of Dhaka National Medical College & Hospital, 2012
Background: Preferred technique of anaesthesia for caesarean section is neuraxial block. Hyperbaric bupivacaine in adequate dose for subarachnoid block often causes complications like hypotension, shivering, nausea, vomiting, chest pain and epigastric pain. Objectives: The aim of study is to reduce the complications of subarachnoid block, improve quality of block, quality of anesthesia, prolong duration of post operative analgesia by reducing total dose of local anaesthetics with the use of adjuvant like fentanyl or clonidine. Methods: Ninety parturients of ASA grade I & II for caesarean section under subarachnoid block were randomly allocated equally into three groups: Group B: hyperbaric bupivacaine 0.5% of 2 ml+ 0.25ml normal saline regarded as controlGroup BC: hyperbaric bupivacaine 0.5% of 1.75 ml + 0.5 ml clonidine (75 ?g)Group BF: hyperbaric bupivacaine 0.5% of 1.75 ml + 0.5 ml fentanyl (25 ?g) Parametric data like pulse, blood pressure among the groups were analyzed by ANOVA...
Journal of Clinical Diagnosis and Research (JCDR)
Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, sideeffects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher's-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value <0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value <0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects.