Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

Abate, Semagn Mekonnen; Belihu, Akine Eshete

doi:10.4103/sja.sja_17_19

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…Low dose spinal anesthesia can reduce the hypotensive effect as proven by the research of Chandra et al It can be an option to facilitate caesarean section in patients with cardiac disorders such as Eisenmenger syndrome. [9][10][11]18,19 Hartono et al reported a similar case.…”

Section: Discussionmentioning

confidence: 84%

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Low Dose Spinal Anesthesia in Pregnant Patient with Eisenmenger Syndrome undergoing Caesarean Section

Tanuwijaya,

Aryasa

2024

J. Med. Health

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Pregnancy with Eisenmenger syndrome is pregnancy with a high mortality rate and it is even recommended not to get pregnant based on the World Health Organization pregnancy risk. The aim of this paper is to present a choice of anesthetic techniques to facilitate pregnant patients with Eisenmenger syndrome undergoing caeasarean section. A 25-year-old woman at 37 weeks' gestation came to the hospital with signs of labor accompanied by comorbid Eisenmenger syndrome. Caesarean section was facilitated with spinal anesthesia with bupivacaine heavy 0.5% 7.5 mg, fentanyl 25 mcg at level L2-L3 while loading 250 ml of crystalloid fluid and preparing norepinephrine drip. The patient's hemodynamics can be stabilized by titrating norepinephrine drip to 0.2 mcg/kg/minute and the patient's shortness of breath is gradually reduced. The patient was treated in intensive care for 2 days and was allowed to be outpatient after 5 days of being treated in the postnatal ward. Appropriate perioperative management can provide optimal results and is expected to prevent fatal perioperative events. As conclusion, low-dose spinal anesthetic techniques can be an option to facilitate caesarean section in pregnant patients with Eisenmenger syndrome.

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Section: Discussionmentioning

confidence: 84%

“…In spite of these two anesthetic options, low dose spinal anesthesia can be an alternative and has been shown to reduce the effects of intraoperative hypotension. [7][8][9][10][11]…”

Section: Introductionmentioning

confidence: 99%

Low Dose Spinal Anesthesia in Pregnant Patient with Eisenmenger Syndrome undergoing Caesarean Section

Tanuwijaya,

Aryasa

2024

J. Med. Health

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“…Brachytherapy is usually used to treat prostate, breast, brain, and cervical cancers. 4 Based on the speed of dosing, brachytherapy can be divided into two techniques, namely high-dose-rate (HDR) and lowdose-rate (LDR). 4,5 Spinal anesthesia techniques are generally suitable for surgical procedures involving the lower abdomen, perineum, and lower extremities.…”

Section: Introductionmentioning

confidence: 99%

“…4 Based on the speed of dosing, brachytherapy can be divided into two techniques, namely high-dose-rate (HDR) and lowdose-rate (LDR). 4,5 Spinal anesthesia techniques are generally suitable for surgical procedures involving the lower abdomen, perineum, and lower extremities. [6][7][8] A local anesthetic solution injected into the intrathecal space prevents the conduction of impulses along motor, sensory, and autonomic nerves.…”

Section: Introductionmentioning

confidence: 99%

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

DM,

Mafiana R,

Zainal R

et al. 2023

JACR

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Introduction: Regional anesthetic techniques and local anesthesia have proven to be more effective than general anesthesia in the practice of ambulatory anesthesia. Spinal anesthesia is the technique of choice for ambulatory anesthesia in cervical cancer brachytherapy patients. Low-dose local anesthetics can speed up the ambulation time. This study aims to compare the ambulation time of low-dose spinal anesthesia with conventional doses. Fast ambulation time can speed up recovery time for patients, thereby reducing the patient's length of stay. Methods: This study was a double-blind, randomized controlled trial conducted in August – September 2022 at the Radiotherapy Installation of Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. All cervical cancer patients undergoing brachytherapy in adults with ASA I-II physical status were included in the study sample. Samples will be randomized into two groups, namely a combination of hyperbaric bupivacaine 5 mg and fentanyl 25 mcg and a group of bupivacaine 2.5 mg and fentanyl 25 mcg. Patients with allergies, impaired motor function, spinal failure, block level not achieved, shock, apnea, respiratory depression, and experiencing pain during the procedure were excluded from the study. Results: Ambulation time in the hyperbaric bupivacaine 5 mg and 25 mcg fentanyl group was longer than the hyperbaric bupivacaine 2.5 mg and 25 mcg fentanyl (155.22 + 10.68 minutes versus 98.69 + 7.13 minutes) with a significance level of p<0.001. Spinal anesthetic drugs work in a dose-dependent manner. Increasing the dose will increase the duration of action of the spinal anesthetic. The only side effects found were hypotension and pruritus. Conclusion: Spinal anesthesia with hyperbaric bupivacaine 2.5 mg and fentanyl 25 mcg can accelerate the ambulation time of cervical cancer patients undergoing brachytherapy.

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“…A recent systemic review and meta-analysis of Ten Randomized trials show Incidence of hypotension was less likely in mothers who received low dose bupivacaine with Fentanyl as compared to those with conventional dose of bupivacaine alone (RR = 0.43, 95% confidence interval (CI) 0.12–0.47, ten trials, 552 participants). The review revealed that Low dose bupivacaine combined with intrathecal Fentanyl decrease the incidence of hypotension [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic and analgesic effect of intrathecal fentanyl with bupivacaine in patients undergoing elective cesarean section; a prospective cohort study

et al. 2022

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Background Spinal anesthesia with bupivacaine has side effects such as hypotension, respiratory depression, vomiting, and shivering. The side effects are dose-dependent, therefore different approaches have been attempted to avoid spinal-induced complications including lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids. Objective To compare the Hemodynamic and analgesic effects of intrathecal fentanyl as an adjuvant with low and conventional doses of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia. Methodology An institutional-based prospective cohort study was conducted on 90 patients. Data was collected with chart review, intraoperative observation, and postoperatively patient interview. Data was entered into EPI INFO and transport to SPSS version 23 for analysis of variables using one-way ANOVA, Kruskal Wallis H rank test, and chi-square. Result Hypotension but not bradycardia, was significantly frequent in a conventional dose of bupivacaine alone (CB) group and a conventional dose of bupivacaine with fentanyl (CBF) groups than that of the lower dose of bupivacaine with fentanyl (LBF) groups. Duration of analgesia was significantly longer in LBF (248± 35.6 minutes) and in CBF groups (260.3±40.3 minutes) than in CB group (167.10 ± 31.45 minutes). Time for the first analgesic request was significantly later in LBF (304±47.8 minutes) and CBF (294.6±99.5 minutes) groups than that in CB group (177±25.88 minutes). Conclusion The Lower dose of bupivacaine is associated with less risk of hypotension and faster recovery. Adding fentanyl with the lower dose of bupivacaine in spinal anesthesia for cesarean section could provide comparable anesthesia with the lower risk of hypotension and longer postoperative analgesia.

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Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

Cited by 10 publications

References 10 publications

Low Dose Spinal Anesthesia in Pregnant Patient with Eisenmenger Syndrome undergoing Caesarean Section

Low Dose Spinal Anesthesia in Pregnant Patient with Eisenmenger Syndrome undergoing Caesarean Section

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

Hemodynamic and analgesic effect of intrathecal fentanyl with bupivacaine in patients undergoing elective cesarean section; a prospective cohort study

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