A comparative study of intrathecal and epidural buprenorphine using combined spinal-epidural technique for caesarean section

Abstract

Neuraxial opioids provide excellent analgesia intraoperatively and postoperatively while allowing early ambulation of the patient by sparing sympathetic and motor nerves. A prospective, randomised double blind study was conducted involving 90 patients of ASA 1 physical status coming for elective cesarean section to evaluate the analgesic effect of neuraxial buprenorphine. They were allocated into three groups. Spinal local anaesthetic was used as the main stay of anaesthesia for surgery and spinal and epidural analgesia with opioids continued as the main stay for postoperative analgesia. All the groups were given 0.5% Bupivacaine intrathecally for the surgery. Besides this, group I was given 150 mcg Buprenorphine intrathecally and group II and III were given 150 mcg and 300 mcg Buprenorphine respectively, epidurally. In the present study, we observed that 150 mcg of Buprenorphine given intrathecally provided much longer duration of analgesia compared to 150 mcg of Buprenorphine given epidurally. Increasing the epidural dose of Buprenorphine from 150 mcg to 300 mcg proved to produce prolonged analgesia comparable to intrathecal Buprenorphine without compromising patient safety and neonatal outcome. The minor side effects were more with intrathecal Buprenorphine than epidural Buprenorphine. We concluded that 300 mcg of Buprenorphine epidurally is equianalgesic to 150 mcg Buprenorphine intrathecally.

Intrathecal hyperbaric bupivacaine with varying doses of buprenorphine for postoperative analgesia after cesarean section: A comparative study

“…using 150 μg buprenorphine. [ 15 ] Results in the present study are comparable with the above studies. This shows that addition of buprenorphine to intrathecal bupivacaine produces prolonged duration of analgesia which is dose-dependent.…”

“…in cesarean section, respiratory depression was not observed even with 150 μg intrathecal buprenorphine. [ 15 ] Being more lipophilic than morphine, rostral spread of intrathecal buprenorphine and therefore the risk of respiratory depression is much less. [ 16 17 18 ] Addition of 60 μg buprenorphine produced increased incidence of minor side effects when compared to control group; however, addition of 45 μg buprenorphine did not produce significant increase in side effects compared to control group.…”

Adjuvants to local anesthetics: Current understanding and future trends

“…Buprenorphine has also been used in intrathecal (75-150 μg) and epidural routes (150-300 μg) with reasonable efficacy[ 5 , 45 ]. Additionally, it has also shown good efficacy when used in a dose of 0.3 mg as an adjuvant to peripheral nerve blocks[ 46 - 48 ].…”

Recommendations for spinal opioids clinical practice in the management of postoperative pain

“…After epidural administration similar maximal concentrations are reached both in plasma and CSF, at 10 and 30 min, respectively and, therefore, it can cause early respiratory depression (within 30 min) that can be resistant to naloxone [9]. Its better characteristics in terms of adverse effects have meant that it is still used clinically, especially in Asian countries, and its effectiveness epidurally has been confirmed at doses of 200 μg injected at two cephalic levels above the surgical incision after lumbar spine surgery in patients given general anaesthesia [52], as well as in caesarean sections at doses of 300 μg epidurally, with the same analgesic quality and, therefore, the same power as the intradural dose of 150 μg [53].…”