Comparative study of analgesic effect of intrathecal bupivacaine and bupivacaine with fentanyl during and after cesarean delivery

  • Dr Satyendra Uike Assistant Professor, Department of Anesthesiology, Bundelkhand Medical College Sagar, MP, India
  • Dr Shashibala Choudhary Senior Resident, Department of Anesthesiology, Bundelkhand Medical College Sagar, MP, India
  • Dr Amit Jain Assistant Professor, Department of Anesthesiology, Bundelkhand Medical College Sagar, MP, India
Keywords: Intrathecal fentanyl, Hyperbaric bupivacaine, Postoperative analgesia

Abstract

Introduction: Neuraxial administration of opioids added to local anesthetics improves the quality of intraoperative analgesia and also provides postoperative pain relief for long duration. The aim of our study was to compare the analgesic effect of subarachnoid block with 10mg ,0.5% hyperbaric bupivacaine with combination of10mg , 0.5% hyperbaric bupivacaine and 12.5 µg fentanyl in parturient posted for elective caesarean section.

Methods: All the parturient of ASA grade 1 and 2 were randomized allocated into two groups of 40 each. Group B received 10mg of 0.5% hyperbaric bupivacaine and group BF received 10mg 0.5% hyperbaric bupivacaine with12.5 µg fentanyl. Characteristics of sensory and motor blockade with hemodynamic parameters were observed, recorded intraoperative and postoperatively.

Results: 10 mg of 0.5% bupivacaine with 12.5 µg fentanyl produces effective level of sensory blockade and less intensive motor blockade, maintains stable intraoperative hemodynamic parameters with decrease incidences of adverse effects like nausea and vomiting, shivering. The total duration of effective analgesia was significantly longer in fentanyl group. Pruritus was significant side effect in fentanyl group.

Conclusion: Intrathecal fentanyl in dose of 12.5µg of fentanyl with bupivacaine for spinal anesthesia in caesarean section provides good intraoperative and significantly reduces the demand for postoperative analgesic with good maternal satisfaction and foetal well being.

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References

1. Datta, S. (2006). Anesthesia for cesarean delivery. Obstetric Anesthesia Handbook, 172-210. [PubMed]

2. Bogra J, Arora N, Shrivastava P. Synergistic effect of Intrathecal Fentanyl and Bupivacaine in spinal anesthesia for caesarean section. BMC Anesthesiology 2005 May 17; 5: 5. doi:10.1186/1471-2253-5-5. [PubMed]

3. Mark Rollins, Jennifer Lucero. Overview of anesthetic considerations for Cesarean delivery. British medical bulletin.Nov 2011; 101(1):105-25.

Rollins M, Lucero J. Overview of anesthetic considerations for Cesarean delivery. Br Med Bull. 2012;101:105-25. doi: 10.1093/bmb/ldr050. Epub 2012 Jan 4. [PubMed]

4. Frederick A, Anderson Jr, Frederick A, Spencer M. Four topics in venous thromboembolism.circulation 2003; 107:1-9-1-16. [PubMed]

5. Aaro LA, Juergens JL.Thrombophlebitis associated with pregnancy.American journal of obstetrics &gynecology 1971 April; 109(8):1128-36. [PubMed]

6. Negishi H et al.Changes in uterine size after vaginal delivery &cesarean section determined by vaginal sonography in the puerperium.Arch Gynecol Obstet .1999 Nov; 263(1-2):13-16.

7. Kuguoglu S, Yildiz H, Tanir MK, Demirbag BC (2012). Breastfeeding after a Cesarean Delivery, Cesarean Delivery, Dr. Raed Salim (Ed.), ISBN: 978-953-51-0638-8, Available from: http://www.intechopen.com/books/cesarean delivery/breastfeeding-after-a-cesarean-delivery. [PubMed]

8. Stanley TH.The history and development of the fentanyl series. J Pain Symptom Manage.1992 Apr; 7(3suppl): S3-7. [PubMed]

9. Bromage PR.Philadelphia; WB saunder; 1978:144. [PubMed]

10. Huskisson EC.Measurement of pain. Lancet 1974 Nov 9; 2(7889):1127-31. [PubMed]

11 Verstraete S, Van de Velde M.Post-cesarean section analgesia.Acta Anaesthesiol Belg. 2012; 63(4):147-167. [PubMed]

12. Gehling M, Tryba M. Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 06/2009 June; 64(6):643-51. [PubMed]

13. Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg. 1992 May; 74(5):653-7.

14. Biswas BN, Rudra A, Bose BK, Nath S, Chakraborthy S, Bhattacharjee S.Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during casarean delivery and in early postoperative period. Indian J Anaesth 2002; 46(6):469-472.

15. Hunt CO, Naulty JS, Bader AM, Hauch MA et al. Perioperative analgesia with subarachnoid fentanyl bupivacaine for cesarean delivery. Anesthesiology.1989 Oct; 71 (4):535-40. [PubMed]

16. Braga AA, Frias JAF,Braga FS,Poterio GB,Hirata ES,Torres NA et al, Spinal anesthesia for cesarean section. Use of hyperbaric bupivacaine (10 mg) combined with different adjuvants. Revista brasileria de anestesiologia; 11/2012; 62(6):775-787.

17. Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anesthesiology 1993; 79; 766-73.

18. Benhamou, Dan MD; Thorin, Dominique MD; Brichant, Jean-Francois MD; Dailland, Philippe MD; Milon, Dominique MD; Schneider, Markus MD. Intrathecal Clonidine and Fentanyl with Hyperbaric Bupivacaine Improves Analgesia During Cesarean Section. Anesthesia & Analgesia.1998;87(3):609-13. [PubMed]

19. Singh H, Yang J, Thornton K, Giesecke AH. Intrathecal fentanyl prolongs sensory bupivacaine spinal block. Can J Anaesth. 1995, Nov; 42(11):987-91. [PubMed]

20. Ben-David B, Solomon E, Levin H, Admoni H et al. Intrathecal fentanyl with small-dose dilute bupivacaine: better analgesia without prolonging recovery. Anesth Analg 1997; 85: 560-65.

21. Chilvers CR, Vaghadia H,Mitchell GW,Merrick PM. Small-dose hypobaric lidocaine-fentanyl spinal anaesthesia for short duration outpatient laparoscopy. II. Optimal fentanyl dose. Anesth Analg. Jan1997; 84(1): 65-70. [PubMed]

22. Atanas Sivevski. Effects of Varying Doses of Plain Bupivacaine with Fentanyl in Patients Undergoing Cesarean Section: Haemodinamics and Neonatal Outcome. www.mjms.ukim.edu.mk (accessed 15 dec 2009).

23. Srivastava U, Kumar A, Gandhi NK, Saxena S, Dutta D, Chandra P et al. Hyperbaric or plain bupivacaine combined with fentanyl for spinal anaesthesia during cesarean delivery. Indian J Anaesth 2004; 48(1):44-46.

24. Chow TC, Cho PH. The influence of small dose intrathecal fentanyl on shivering during transurethral resection of prostate under spinal anesthesia.Acta Anaesthesiol Sin. 1994 Sep; 32(3):165-70.

25. Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl is superior to intravenous ondansetron for prevention of perioperative nausea during caesarean delivery with spinal anaesthesia. Anesth Analg 2000 May; 90(5): 1162-6. [PubMed]

26. Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg. 1997 Dec; 85(6):1288-93. [PubMed]

27. Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Berzina CE, Baraka AS. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg. 2002 Jul; 95(1):209-13.
CITATION
DOI: 10.17511/ijmrr.2015.i3.045
Published: 2015-04-30
How to Cite
1.
Uike S, Choudhary S, Jain A. Comparative study of analgesic effect of intrathecal bupivacaine and bupivacaine with fentanyl during and after cesarean delivery. Int J Med Res Rev [Internet]. 2015Apr.30 [cited 2024Nov.23];3(3):256-62. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/221
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Original Article