Minimum Appropriate Dose of Lidocaine with a Fixed Dose of Sufentanil - epinephrine Used for Spinal Anesthesia in Caesarian Section

Abstract

It can be indicated that using 50 mg of lidocaine, instead of 75 mg, in combination with opioids and epinephrine in mothers that are candidates for C/S not only provides an acceptable anesthesia level but also offers a more stable hemodynamic state with fewer side effects and less of a need for drugs to control blood pressure and vomiting.Background: Caesarian section is a commonplace surgery in females for which spinal anesthesia is the preferred method. The local anesthetic medications used in the surgery are often associated with complications such as nausea, vomiting, dyspnea, hypotension, and bradycardia. In the present study, we decreased the dose of the anesthetic drug and added an opioid instead. Objectives: We tried to find an appropriate combination of medications required for optimal anesthesia with minimum complications. Patients and Methods: One hundred twenty six candidates for C/S with first and second class ASA aged 18-35 years were randomly divided into three groups. All patients received sufentanil (2.5 µg) and epinephrine (100 µg) doses but the lidocaine doses were respectively 50 mg, 60 mg and 75 mg in the groups 1, 2 and 3. Complications including hypotension, bradycardia, dyspnea, nausea, vomiting, and anesthesia quality were recorded and statistically analyzed. Results: The level of anesthesia was significantly different between groups. By reducing the lidocaine dose, patients with anesthesia level under the nipple increased but the surgeon and the patient were satisfied with the results. Nausea, vomiting, and dyspnea was degraded by decreasing the lidocaine dose especially in the 50 mg group. The need to use ephedrine was directly associated with the lidocaine. However, the need to use atropine was not significantly different between groups. Pruritus was not significantly different as well. Conclusions: It seems that reducing the lidocaine dose, when combined with sufentanil, decreases most complications of spinal anesthesia such as hypotension, dyspnea, nausea, and vomiting while preserving anesthesia quality.

Comparison of Adding Sufentanil and Low-Dose Epinephrine to Bupivacaine in Spinal Anesthesia: A Randomized, Double-Blind, Clinical Trial

“…It is also reported that sufentanil causes sensory changes. Previous studies reported decreased sensation of pinprick and cold in labor analgesia ( 7 , 13 ).…”

“…It seems that intratechal bupivacaine alone has rapid onset of sensory blockade and is an adequate local anesthetic for lower limb surgeries ( 2 ). The prolongation effect of epinephrine in spinal anesthesia is still a debate; some studies support the idea while others fail to do so ( 7 , 10 , 11 ). The current study results, however, were consistent with those of the later studies, since the current study used a dose of 0.01 mg epinephrine added to isobaric bupivacaine; this dose was less than those used in previous studies.…”

“…Respiratory depression, however, is proposed as a complication. This can result from direct cephalic distribution of cerebrospinal fluid or plasma accumulation and systemic absorption of the drug ( 7 ). It is also reported that sufentanil causes sensory changes.…”

“…Sufentanil, an opioid known for its rapid onset of pain relief, gained attention among anesthesiologists, while its duration of action is relatively short ( 7 ). Epinephrine, however, is used alongside local anesthetics to prolong the analgesia due to its vasoconstrictive effects and reduction of local blood flow ( 2 , 8 ).…”

The Analgesic Efficacy of Intrathecal Bupivacaine and Fentanyl with Added Neostigmine or Magnesium Sulphate

“…Therefore, complications, such as delayed respiratory depression, occur less frequently with fentanyl ( 6 ). Other opioids, such as pethidine, have been used successfully in combination with local anesthetics for spinal anesthesia ( 7 , 8 ). Adjuvant spinal drugs, such as epinephrine, clonidine, and neostigmine, can increase the duration and potency of spinal anesthesia ( 8 ).…”