A Comparative Study on Three Different Doses of Fentanyl with Bupivacaine in Spinal Anaesthesia in Caesarean Section

Abstract

BACKGROUND Spinal anaesthesia is the technique of choice for caesarean section as it is devoid of many potential problems associated with general anaesthesia. The usual dose required for reaching the desired block height for hyperbaric bupivacaine is 10-12 mg. A lower dose of bupivacaine with an adjuvant is used as a reliable combination which produces synergistic effect, prolonging the duration of sensory block without increasing sympathetic block or delaying recovery. METHODS A total of 110 patients undergoing elective or emergency Caesarean section under spinal anaesthesia, were screened for eligibility and 105 were randomised in the trial, allocated to 3 groups to receive injection bupivacaine 7.5 mg along with fentanyl 15 mcg (Group BF1, n=35), fentanyl 20 mcg (Group BF2, n=35), fentanyl 25 mcg (Group BF3, n=35). RESULTS The average time required to reach the block height of T4-T6 was around 3.26 min in BF1, 3.97 min in BF2, 4.63 min in BF3. The two-segment regression time of BF1 was 68.06 min; BF2 72.17 min and BF3 80.06 min. The recovery time of sensory block for BF1 is around 129.71 min, for BF2, 193.43 min and for BF3 200.86 min. The time for onset of motor block was BF1 1.49 min, BF2 1.51 min and BF3 2.34 min. The time to maximum of motor block was 2.8 min for BF1, 3.69 min for BF2, 7.8 min for BF3. The recovery time of motor block for BF1, was 107.14 min; BF2, 91.57 min and BF3, 65.66 min. CONCLUSIONS All the three doses of fentanyl-15mcg, 20mcg, 25mcg can be used as an adjuvant to 7.5 mg of 0.5% heavy bupivacaine for caesarean section to provide good quality surgical anaesthesia. Larger fentanyl dose group (25mcg) scores over small dose group in terms of sensory block with prolonged post-operative analgesia, early motor recovery and lesser incidence of hypotension.

Comparison Between Intrathecal Neostigmine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Spinal Anaesthesia for Post-Operative Pain Relief

“…Also, the mean time to onset of sensory block in Group F was 01 minute 36 seconds (approx.) and was similar to the studies on intrathecal Fentanyl by Dalvi NP et al [16] and Nahakpam S et al [17].…”

Perbandingan Anestesi Spinal Bupivakain Low Dose dan Conventional Dose dalam Mencapai Adekuasi Blok Sensorik untuk Prosedur Seksio Sesarea: Penelitian Noninferioritas Acak Tersamar Tunggal

“…3 Bupivakain tunggal atau dikombinasikan dengan narkotik merupakan obat anestesi lokal paling umum digunakan pada anestesi spinal untuk prosedur seksio sesarea. 4 Dosis konvensional bupivakain hiperbarik yang digunakan untuk mencapai ketingian blok pada prosedur seksio sesarea adalah 10-12 mg. 5 Bahkan dari buku ajar anestesi merekomendasikan dosis bupivakain 12-15 mg. Namun demikian penggunaan kisaran dosis ini telah dikaitkan dengan hipotensi maternal 69% hingga >80%, yang mengakibatkan morbiditas pada ibu dan janin. 6,7 Akhir-akhir ini seksio sesarea dengan menerapkan protokol Enhanced Recovery After Caesarean Section (ERACS) menjadi pembahasan dan banyak diadopsi diseluruh dunia.…”

“…Dosis rendah bupivakain dengan adjuvan opioid merupakan kombinasi handal yang digunakan yang memberikan efek sinergis, memperpanjang durasi blok sensorik tanpa memperberat blok simpatis atau memperlambat pemulihan. 5 Morfin intratekal diakui sebagai gold standard untuk tatalaksana nyeri pascaseksio sesarea. 9…”