Comparative Study of Intrathecal Fentanyl Versus Intravenous Fentanyl For Supplementation of Subarachnoid Block During Caesarean Section
Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 4
Abstract
Background: Pain during cesarean section is a common phenomenon which results release of stress hormone during surgery. In contrast, effective analgesia may permit improved mother-child bonding, early ambulation, discharge, greater patient satisfaction and early breastfeeding. Now a days the use of intrathecalfentanyl as multimodal analgesia became a popular technique for cesarean section, because of synergistic effect with local anaesthetic and intensify sensory block without increasing sympathetic block. Aims: To evaluate the efficacy and compare intrathecal fentanyl and intravenous fentanyl for supplementation of subarachnoid block with intrathecal bupivacaine during caesarean section and to evaluate any adverse maternal or neonatal outcome. Methods: This study was carried out on 60 patients posted for elective LSCS. Patients were randomly allocated into two groups compromising of 30 patients each. Intrathecal fentanyl group patients received bupivacaine 10mg (2ml) and fentanyl 12.5microgram (0.25ml) intrathecally and 0.25ml normal saline intravenously. Intravenous fentanyl group patients received bupivacaine 10mg bupivacaine (2ml) and 0.25ml of normal saline intrathecally and 0.25ml fentanyl (12.5microgram) intravenously. All patients were preloaded with 500ml ringer lactate solution. Lumber puncture was performed in the sitting position by midline approach at L2-3 or L3-4 intervertebral space with 25 gauge spinal needle. Immediately after intrathecal administration of local anaesthetic 12.5microgm (0.25ml) fentanyl was administered intravenously in intravenous fentanyl group whereas 0.25 ml normal saline was injected in the intrathecal fentanyl group patients. Results: There are no significant differences between the intrathecal fentanyl group and intravenous fentanyl group with respect to age, height, weight, gestational age and parity. Intrathecal injection to delivery time and duration of surgery didn’t differ between the two groups. There was a significant difference in time required for T6 sensory block , duration of sensory block and time of first rescue post-op analgesia with intrathecal fentanyl group giving better results. The incidence of severe hypotension defined as BP<90mmHg and mephentermine requirement was more frequent in the intravenous fentanyl group as compard with the intrathecal group. There was no significant statistical difference in incidence of adverse effects such as nausea, vomiting, pruritis. Respiratory depression was absent in all patients and neonates of both the groups. The apgar scores of all neonates in both groups were >8 at 1 min and >9 at 2 min. Conclusion: Addition of intrathecalfentanyl as an adjuvant to bupivacaine for emergency cesarean section increased duration of analgesia, reduced postoperative analgesia consumption and request time without any maternal and fetal effect. We recommend the use of intrathecal fentanyl for emergency caesarean section in our set up.
Authors and Affiliations
Irshad Yousuf, Mir Mujtaba Ahmad, Sayika Hameed, Raja Nadeem
Keywords
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- EP ID EP546737
- DOI 10.21276/ijmrp.2017.3.4.024
- Views 93
- Downloads 0
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