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Comparision of Bupivacaine alone and its Combination with Different Doses of Fentanyl in Spinal Anesthesia for Cesarean Section: a Prospective Randomized Study
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Background: Intrathecal administration of local anesthetics alone does not provide adequate analgesia during caesarian sections. The visceral pain associated with peritoneal traction can be obliterated by the addition of intrathecal opioid, due to their synergism.
Aims: The aim of this study was to observe the effect of intrathecal bupivacaine alone and in combination with fentanyl in two different doses.
Settings and Design: We performed a prospective randomized study on 90 consecutive patients undergoing caesarian section in our hospital.
Methods and Material: Ninety selected patients, who underwent cesarean section, of age ranging from 20-35 years, were randomized into three equal groups. Group I received hyperbaric bupivacaine (B) alone, where as group II and group III received hyperbaric bupivacaine along with 12.5 μg and 25 μg of fentanyl respectively (BFL&BFH). The quality and durations of analgesia was compared between the three groups. The effects of drug on neonate were monitored on the basis of Apgar score.
Statistical analysis: Unpaired't' test&'Z' test were used for statistical analysis.
Results: There were no differences in regard to Apgar scores between all three groups. The synergistic advantages were evident in both combination groups with respect to patient's comfort and ease of surgeons; but the maternal side effects were more in the group with higher dose of fentanyl (BFH). No adverse effect on neonates was observed in all three groups.
Conclusion: Since the clinical dose of spinal bupivacaine required to obliterate visceral pain causes undesirable side effects. Addition of fentanyl with bupivacaine, reduces the dose of local anesthetics in achieving adequate surgical anesthesia. We conclude that the combination of 12.5 μg of fentanyl along with 2ml of 0.5% hyperbaric bupivacaine achieved adequate anesthesia with minimal maternal and neonatal adverse effects.
Keywords
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