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

Abstract

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.

Incidence of hypotension in lower segment Caesarean section - a comparison of intrathecal Fentanyl- Bupivacaine combination with Bupivacaine alone

“…In the group that received bupivacaine and fentanyl, there was a noticeable 36.6% incidence of complete motor block development, which was notably different from the group that only received bupivacaine. These findings are in line with previous research 9 . Interestingly, some authors have suggested that bupivacaine alone may be just as effective as the combination of bupivacaine and fentanyl in producing a quality motor block 17 .…”

“…Randomly allocated two distinct groups using sealed envelope technique were formed for the study. The sample size was calculated by using standard protocol and previous study 9 . Sample size (n)= ((Z_ (∝) +Z_β) ^ (2) ∝SD∝^2)/d^2 Where, SD (standard deviation = 2.52 as per previous study 9 ) and desirable error (d)=1, Confidence interval 95% CI =0.84, and the power of test at 80%.…”

“…The sample size was calculated by using standard protocol and previous study 9 . Sample size (n)= ((Z_ (∝) +Z_β) ^ (2) ∝SD∝^2)/d^2 Where, SD (standard deviation = 2.52 as per previous study 9 ) and desirable error (d)=1, Confidence interval 95% CI =0.84, and the power of test at 80%. The final calculated sample size is 49.14, thus taken as 50 in each group.…”

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

“…There was no statistical difference in the other side reactions, and all of which were mild and occured during administration, and usually return to normal before leaving the operation room. However, other studies suggested that esketamine did not increase maternal side effects [ 29 , 30 ], this discrepancy might due to the inconsistency with the observation time and administration mode. Therefore, the effect of a smaller dose of esketamine on postpartum depression should be studied in the future to reduce maternal discomfort.…”

“…However, post-spinal hypotension, relatively short duration,not sufficient postoperative analgesia are all the drawbacks of SA. A series of measures can compensate for the shortcomings of SA, such as neuraxial administration of opioids or a2 adrenergic receptor agonists, reducing the dosage of bupivacaine, can prolong the time for the first rescue analgesia, and reduce the occurrence of intraoperative hypotension [ 28 , 29 ]. Unfortunately, these measures are not routinely performed in our hospital, so no drugs other than local anesthetics were added into the subarachnoid space in this study.…”