Epidural Anaesthesia for Cesarean Section: A Comparison of 0.5% Bupivacaine and 0.5% Bupivacaine Plus 50µg Fentanyl
Journal Title: International Journal of Research and Review - Year 2018, Vol 5, Issue 2
Abstract
Introduction: 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: To compare the onset of surgical anesthesia and analgesia of epidural 0.5% bupivacaine with or without 50 µg of fentanyl. To compare the intensity and quality of surgical anesthesia with I.V analgesics and /or N2O-O2 by mask, of epidural blocks with 0.5% bupivacaine with or without 50µg of fentanyl. To evaluate the newborn condition by Apgar score. To study side effects and complication (if any) of addition of 50µg of fentanyl with 0.5% bupivacaine for epidural anesthesia for cesarean section. Materials & Methods: In our study we randomized 40 parturients to receive epidural anesthesia with either 0.5% bupivacaine only or 0.5% bupivacaine with 50mg of fentanyl for elective cesarean section, to compare the effect of bupivacaine alone and bupivacaine+fentanyl in surgical anesthesia as well as the maternal and fetal outcome. The patients were randomly divided into two groups of 20 patients each. In Group A, parturient were given epidural block with 18ml of 0.5% bupivacaine + 2m1 of placebo (Normal Saline). In Group B, parturient were given epidural block with 18m1. of 0.5% bupivacaine + 50µg(1m1) of fentany1+1m1 normal saline. Result: The mean total dose of bupivacaine 0.5% was 20.85±3.07 ml. in Group A and 18.75±1.87 ml. in Group B, so the total dose of bupivacaine required by Group A patients was significantly greater than Group B. Addition of 50mg fentanyl with 0.5% bupivacaine for epidural anaesthesia for cesarean section does not affect the I-S; S-D; U-D intervals significantly. Regarding the intra-operative complications, incidence of Nausea/Vomiting and shivering was slightly more in the Group-B (bupivacaine+fentanyl) than the Group A (bupivacaine only), but the difference was statistically not significant. None of infant was severely depressed at 5 mins in either group in our study. Conclusion: This can be concluded that addition of 50mg fentanyl with 0.5% bupivacaine for epidural anesthesia for elective cesarean section provides a faster, better quality of intraoperative anesthesia without any adverse effect on maternal and newborn outcome.
Authors and Affiliations
Dr Anurag Agarwal
Keywords
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