Addition of Fentanyl to Hyperbaric Bupivacaine in spinal anesthesia for Caesarian section – effect on dose of local anesthetic and duration of postoperative analgesia – a randomized comparative study
Journal Title: Journal of Medical Sciences - Year 2017, Vol 20, Issue 2
Abstract
Background: Spinal anesthesia is commonly used for the caesarian section for its reliability and ease of administration. However, it is limited by fixed duration of anesthesia, hypotension and lesser control of block height. The combination of a reduced dose of local anesthetic agent with intrathecal opioid makes it possible to achieve adequate spinal anesthesia with minimum hypotension and prolonged postoperative analgesia. The study aims to monitor the effect of intrathecal fentanyl and bupivacaine on reduction of higher blocks and simultaneously improving the quality and avoiding higher doses of local anesthesia agents. Methods: Forty patients scheduled for elective caesarian section were divided in to two groups of twenty each. Group I patients received Bupivacaine 12.5 mg (0.5%) for spinal anesthesia and group II patients received combination of Bupivacaine 8.5 mg (0.5%) with fentanyl 25 mcg. Patients were observed for hypotension, bradycardia, nausea, pruritus, quality of surgical anesthesia and duration of postoperative analgesia. Results: All the patients had adequate surgical anesthesia for the procedure and in no patient conversion to general anesthesia was required. Peak sensory level was higher (T2-T3 vs T4-T6) and motor block was more intense in the regular dose bupivacaine group of patients. More patients in bupivacaine only group developed hypotension and the requirement of vasopressors was significantly higher than the low dose bupivacaine with fentanyl group. Also the Visual analogue scale score for pain was less in the bupivacaine-fentanyl group, who received less postoperative analgesics for first twelve hours. Conclusions: We conclude that the combination of low dose bupivacaine (8.5mg) with fentanyl provides adequate surgical anesthesia for caesarian section and with low incidence of hypotension and nausea. Also, addition of fentanyl helps in prolongation of postoperative analgesia.
Authors and Affiliations
Ghulam Mohammed Mir, Mohammed Abdul Haadi
Keywords
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