Title: Effects Fentanyl on Hyperbaric Bupivacaine in Spinal Anaesthesia for Caesarean Section

Authors: Gopichand K, Suresh T

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i8.06

Abstract

Hyperbaric bupivacaine was the most common drug used in spinal anaesthesia for caesarean section. The aim of this study was to compare the effects of adding fentanyl to intrathecal bupivacaine on the onset and duration of spinal anaesthesia. Sixty healthy parturients with singleton pregnancy scheduled for elective caesarean section were randomly allocated to receive subarachnoid block with 2ml of 0.5% hyperbaric bupivacaine in control group C and 2ml of 0.5% hyper baric bupivacaine + fentanyl 20 mcg(0.4ml). Blood pressure, heart rate, respiratory rate, oxygen saturation, along with characteristics of spinal block were assessed throughout the surgery and in the postoperative ward until the patient requested for analgesia. Onset of sensory and motor block was comparable in both groups. Two segment regression (80.34±13.34 vs135.54±10.56 min) and the duration of analgesia (190.24±20.32 vs210.52±18.92 min) was significantly prolonged in fentanyl group.  Addition of 20mcg fentanyl   as adjuvant to 2ml of 0.5%hyperbaric bupivacaine  intrathecally provides  better surgical analgesia, prolongs the duration of analgesia, reduces the intra-operative need of analgesic supplement, delays time of postoperative rescue analgesia with minimal side effects.

Keywords-Fentanyl, hyperbaric bupivacaine, spinal, anaesthesia, caesarean section.

References

 

1.      Dyer RA, Joubert IA;  Low dose spinal anesthesia for caesarean section. Curropin Anaesthsiol17:301-308

2.      Choi DH, Ahn HJ, Kim MH (2000) Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery RegAnesth Pain Med 25: 240-245.

3.      Clur,Duck- Hwan, Ahn, Hyun-Joo.Spinal anesthesia for cesarean section- a comparison of three doses of hyperbaric bupivacaine mixed with fentanyl.Br J Anaesth 1999;82:159.

4.      Jaishri Bogra, Namita Arora, Pratima Srivastava. Synergistic effect of intrathecal fentanyl and bupivacaine inspinal anesthesia for cesarean section. BMC Anesthesiology 2005,5,5.

5.      Arawal A, Agrawal S, Asthana V, Payal, Y.S. Comparison of Intrathecal Fentanyl and Sufentanylin addition to bupivacaine for cesarean section under spinal anesthesia. J Anaesth Clin Pharmacol 2009, 25(2): 154_156.

6.      Sibilla C, Albertazzi P, Zatelli R et al. - Perioperative analgesia for caesarean section: comparasion of intrathecal mor-phine and fentanyl alone or in combination. Int J ObstetAnesth, 1997;6:43-48.

7.      Karaman S, Kocabas S, Uyar M et al. - The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol, 2006;23:285-291.        

8.      Braga AFA, Braga FSB, Potério B et al. - Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol, 2003;20:631-635.

9.      Dyer RA, Joubert IA - Low-dose spinal anaesthesia for Caesarean section. CurrOpinAnaesthesiol, 2004;17:301-308.

10.  Lavand'homme PM, Roelants F, Waterloos H et al. - An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg, 2008;107:948-955.   

11.  Coppejans HC, Vercauteren MP (2006) Low-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics Acta Anaesthesiol Belg 57: 39-43.

12.  Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, et al. (2003) Comparison of the effects of intrathecalropivacaine, levobupivacaine, and bupivacaine for Caesarean section Br J Anaesth 91: 684-689.

13.  Ben-David B Miller G, Gavriel R, Gurevitch A (2000) Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery Reg Anesth Pain Med 25: 235-239.

14.  Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, et al. (2002)  Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery Anesth Analg 95: 209-213, table of contents.

15.  Gadsden J, Hart S, Santos AC (2005) Post-cesarean delivery analgesia Anesth Analg 101: S62-69.

16.  Rathmell J P, Lair T R, Nauman B 2005 The role of intrathecal drugs in the treatment of acute pain., AnesthAnalg 101: S30-43.

17.  P.R.Dhumal, E.P.Kolhe, V.B.Gunjal, V.A. Kurhekar. ISynergistic effect of intrathecal fentanyl andbupivacaine combination for cesarean section. J Pharm Biomed Res 2013,4(1),50-56.

18.  Jaishri Bogra, Namita Arora, Pratima Srivastava. Synergistic effect of intrathecal fentanyl and bupivacaine inspinal anesthesia for cesarean section. BMC Anesthesiology 2005,5,5.

19.  Arawal , A., Agrawal S., Asthana V., Payal, Y.S. Comparison of Intrathecal Fentanyl and Sufentanyl inaddition to bupivacaine for cesarean section under spinal anesthesia. J Anaesth Clin Pharmacol 2009, 25(2):154_156.

20.  G.Dahlgren G, Hultstrand C, Jakobsson J.,Norman M. Intrathecal Sufentanyl , Fentanyl, or placebo added tobupivacaine for cesarean section . Anesthesia Analgesia 1997,85, 1288-1293.

21.  Wang, Chakrabarati M.K.,Whitwam,J.G. Differentiation effect of Alfentanyl, fentanyl, pethidine andlignocaine administered intrathecally on nociceptive responses evoked by low and high frequency stimulation of somatic nerves. Anesthesiology 1993,79,766-773.

22.  P.R.Dhumal, E.P.Kolhe*, V.B.Gunjal, V.A.Kurhekar. ISynergistic effect of intrathecal fentanyl and bupivacaine combination for cesarean section. J Pharm Biomed Res 2013,4(1),50-56.

23.  Shende D, Cooper, GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for cesarean section. Anaesthesia 1998, 53, 706-710.

Corresponding Author

Suresh T

Assistant Prof., Dept of Anaesthesia

Mamata Medical College, Khammam-507002,Telangana State, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No.8019317889