Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

Weigl, Wojciech; Bieryło, Andrzej; Wielgus, Monika; Krzemień-Wiczyńska, Swietłana; Kołacz, Marcin; Dabrowski, Michal

doi:10.1097/md.0000000000008892

Cited by 37 publications

(48 citation statements)

References 49 publications

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“…Other researchers have reached a similar conclusion, and a decrease in intraoperative pain with spinal morphine was seen in some studies [19], [20]. In the event of a short time interval between spinal puncture and the start of a C-Section, Weigl W. et al, also suggest a mixture of two opioids-fentanyl and morphine-addled to LA, thus confirming the previous statements [21].…”

Section: Discussionsupporting

confidence: 69%

Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

Sivevski¹,

Ivanov²,

Karadjova³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients. METHODS: Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Spinal anaesthesia was performed with a mixture of 8-9 mg isobaric 0.5% bupivacaine, 20 mcg fentanyl and 100 mcg morphine (total volume 2.2-2.4 ml). Blood pressures (BP)-SBP, DBP, MAP were recorded non-invasively before performing spinal anaesthesia and at 2.5 minutes after a spinal puncture. RESULTS: The BP falls (%) from baseline were significantly greater in the healthy parturients compared to those with preeclampsia (25.8% ± 10.1 vs 18.8% ± 17.0 for SBP, 28.5% ± 8.8 vs 22.5% ± 10.4 for DBP, and 31.2% ± 14.2 vs 18.2% ± 12.6% for MAP, p < 0.05). The incidence rate of hypotension in the preeclamptics was 25% compared to 53% in healthy parturients (p < 0.001). Higher doses of vasopressors both ephedrine (16.5 ± 8.6 vs 6.0 ± 2.0 mg) and phenylephrine (105 ± 25 mg) in the healthy women were required. There was no need for phenylephrine treatment in the preeclamptic group. CONCLUSION: This study showed that the incidence and severity of spinal-induced hypotension in preeclamptic patients are less than in healthy women. The use of low dose spinal anaesthesia also contributed to this statement.

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Section: Discussionsupporting

confidence: 69%

Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

Sivevski¹,

Ivanov²,

Karadjova³

et al. 2019

Open Access Maced J Med Sci

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“…Adding intrathecal fentanyl to bupivacaine improved initial analgesia [58]. However, when morphine is also added to the intrathecal mixture, fentanyl might induce acute opioid tolerance and result in greater opioid consumption [59].…”

Section: Neuraxial Adjuvant Drugsmentioning

confidence: 99%

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language between 1 May 2014 and 22 October 2020 evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane databases. Studies evaluating pain management for emergency or unplanned operative deliveries or caesarean section performed under general anaesthesia were excluded. A total of 145 studies met the inclusion criteria. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, recommendations include intrathecal morphine 50-100 µg or diamorphine 300 µg administered pre-operatively; paracetamol; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone administered after delivery. If intrathecal opioid was not administered, single-injection local anaesthetic wound infiltration; continuous wound local anaesthetic infusion; and/or fascial plane blocks such as transversus abdominis plane or quadratus lumborum blocks are recommended. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs with opioids used for rescue. The surgical technique should include a Joel-Cohen incision; non-closure of the peritoneum; and abdominal binders. Transcutaneous electrical nerve stimulation could be used as analgesic adjunct. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.

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“…Several studies have been conducted to elucidate the efficacy of intrathecal ropivacaine with adjuvants such as fentanyl (Chung et al, 2002) and sufentanil (Sun et al, 2001;Chen et al, 2010) in cesarean delivery. But intrathecal opioids will increase nausea and vomiting (Weigl et al, 2017) and itching (Sun et al, 2001;Chen et al, 2010;Sun et al, 2017) that is an uncomfortable experience and prolong the recovery for the parturients after the surgery. Intrathecal dexmedetomidine, an a 2 -adrenergic receptor agonist used as an adjuvant to bupivacaine, has been found to provide better intraoperative nerve blockade than bupivacaine alone as well as prolong postoperative analgesia and alleviate shivering in patients undergoing cesarean section (Bi et al, 2017;He et al, 2017;Xia et al, 2018;Liu et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

Zhang

et al. 2020

Front. Pharmacol.

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In this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section. Methods: Seventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 mg (RD3 group) and 5 mg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored. Results: The onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05). Conclusion: 3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia,

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Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

Abstract: Supplemental Digital Content is available in the text

Cited by 37 publications

References 49 publications

Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section

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