Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section

Abstract

BackgroundSubarachnoid block is widely used for cesarean section due to the rapid induction, the complete analgesia, the low failure rate and the prevention of aspiration pneumonia. The addition of intrathecal opioids to local anesthetics seems to improve the quality of analgesia & prolong the duration of analgesia. Therefore we compared the effects of fentanyl 20 µg and sufentanil 2.5 µg, which were added to intrathecal hyperbaric bupivacaine.MethodsSeventy two healthy term parturients were randomly divided into three groups: Group C (control), Group F (fentanyl 20 µg) and Group S (sufentanil 2.5 µg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen by Harten et al. We observed the maximal level of the sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and the side effects.ResultsThere were significant differences between the control and the fentanyl 20 µg and sufentanil 2.5 µg groups for the degree of muscle relaxation, the quality of intraoperative analgesia, the maximal sedation level and the duration of effective analgesia. The frequencies of side effects such as nausea and pruritis in the opioid groups were higher than those in the control group. But there were no differences between fentanyl 20 µg and sufentanil 2.5 µg for the frequencies of nausea and pruritis.ConclusionsThe addition of fentanyl 20 µg or sufentanil 2.5 µg for spinal anesthesia provides adequate intraoperative analgesia without significant adverse effects on the mother and neonate.

Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study

“…Thus, newborn infants showed no signs of fetal distress. Our results were similar to those described in the literature, proving that the drug combination is safe in the doses used 7,9,19,21,28 .…”

“…In the last decades, the increased use of spinal sufentanil in combination with local anesthetics has been observed 1,2,[5][6][7][20][21][22][23] . In spinal blocks for labor analgesia and cesarean section, it has been described that the potency of sufentanil is increased around In our study, pain was reported by four patients who received fentanyl and three patients from the sufentanil group, occurring at a mean time of 96 and 81 minutes, respectively.…”

Spinal fentanyl vs. sufentanil for post‐operative analgesia after C‐section: a double‐blinded randomised trial

“…7 Although the relative potencies of these two opioids are well known for intravenous administration, they cannot be extrapolated to intrathecal administration. On the other hand, Lee et al 9 compared IT fentanyl 20 lg to IT sufentanil 2.5 lg (i.e. Dosages were chosen, most often according to the study of Nelson et al 3 who reported the relative potency for IT fentanyl to sufentanil in labour analgesia to be 1 : 4.4 at the ED50 level.…”

“…The most common are itching, nausea/vomiting, hypotension and delayed respiratory depression. 6,7,9,10 These side effects appear to be dependent on the lipophilic character of the opioid used. 3,6,7,11 Morphine is less lipid soluble and takes longer time to penetrate neural tissues.…”

“…Dahlgren et al 6 reported that 10 lg fentanyl added to hyperbaric bupivacaine for caesarean section had a shorter duration of action than sufentanil 2.5 and 5 lg. On the other hand, Lee et al 9 compared IT fentanyl 20 lg to IT sufentanil 2.5 lg (i.e. a ratio of 1 : 8), when added to hyperbaric bupivacaine for caesarean section and found no difference between the two agents with regard to the effective duration of analgesia.…”