Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

Abstract

INTRODUCTIONNeuraxial block for lower segment cesarean section (LSCS) has become increasingly popular amongst parturients, as most of them prefer being awake during birth of the baby.1 Many practitioners prefer spinal anaesthesia to epidural block because of simplicity of technique, rapidity in onset of action and reliability in producing uniform sensory and motor blockade as also avoiding the much dreaded complication of aspiration due to delayed gastric emptying as seen with general anaesthesia. 2-4The disadvantages however are limited duration of action, lack of long lasting post-partum analgesia and visceral pain during manipulation of uterus or at the time of peritoneal closure associated with intra-operative nausea and vomiting. To overcome these problems, ABSTRACTBackground: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 µg and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5% hyperbaric bupivacaine for caesarean section. Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under spinal anaesthesia in a randomized, prospective double blind comparative method in Lokmanya Tilak Municipal General Hospital after taking approval from hospital ethics committee. After fulfilling requirements of inclusion criteria patients were randomly divided into 2 groups of 30 each. Study group (BS) received intrathecal sufentanil 5 µg with 8 mg of 0.5% hyperbaric bupivacaine and the control group (B) received intrathecal 0.5% hyperbaric bupivacaine 10 mg. Pre, intra and postoperative investigations were made accordingly. Results: No significant differences were observed among demographic parameters like age, weight, height and duration of surgery (p>0.05). The results were statistically significant (p<0.05) when the two groups were compared for the sensory blockade and motor blockade and the time to first analgesic requirement was significantly (p<0.05) prolonged in group BS as compared to group B. Both the groups showed decrease in pulse rate as compared to the baseline in the intra-operative and postoperative period. A significant (p<0.05) fall in the systolic blood pressure in B group was observed compared to BS group from 4 min to 75. None of the patients in either group developed respiratory rate <10 per minute and fall in oxygen saturation throughout the observation period. The sedation scores of the both groups were comparable and are statistically significant (p<0.05) with each other. Conclusions: A reduced dose of 0.5% hyperbaric bupivacaine (8 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for cesarean section with better hemodynamic stability and low incidence of minor side effects as compared to 10 mg hyperbaric bupivacaine.