Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial

Ferrarezi, Wesla Packer Pfeifer; Braga, Angélica de Fátima de Assunção; Ferreira, Valdir Batista; Mendes, Sara Quinta; Brandão, Maria José Nascimento; Braga, Franklin Sarmento da Silva; Carvalho, Vanessa Henriques

doi:10.1016/j.bjane.2021.03.030

“…It has the characteristics of fast peaking, a strong analgesic effect, and a short half-life. It is widely used in postoperative intravenous analgesia, but it can cause many adverse reactions, such as nausea, vomiting, urinary retention, and respiratory depression [ 9 ]. At the same time, maternal anxiety, chills, nausea, and vomiting are prone to adverse reactions during cesarean section [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Anesthetic Effect and Safety of Dexmedetomidine in Cesarean Section: A Meta-Analysis

Pang

¹

,

Zhu

²

,

Yan

³

et al. 2022

BioMed Research International

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Objective. To evaluate the anesthetic effect and safety of dexmedetomidine in cesarean section. Methods. The Cochrane Library, EMBASE, and PubMed databases (established until September 2020) were searched by computer. Two authors independently screened and extracted literature related to the application of dexmedetomidine in the cesarean section according to inclusion and exclusion criteria. The control group received either subarachnoid block (lumbar anesthesia) or combined lumbar anesthesia and epidural anesthesia (combined lumbar epidural anesthesia) with bupivacaine or combined bupivacaine and fentanyl. The observation group was additionally given dexmedetomidine based on the control group, to analyze the anesthetic effect and safety of dexmedetomidine in cesarean section. Results. A total of 580 cesarean delivery women were included in 8 studies, and the results showed that the peak time of sensory block in the observation group was shorter than that in the control group (standard mean difference = − 0.28 ; 95% confidence interval: -0.48, -0.08; P = 0.006 ), sensory block lasted longer than that in the control group (standard mean difference = 1.49 ; 95% confidence interval: 1.21, 1.78; P < 0.00001 ), the sedation rate was higher than that in the control group, the onset of the first postoperative pain was significantly delayed compared with that in the control group, and the incidence of postoperative pain, nausea and vomiting, postoperative chills, and fever was lower than that in the control group ( P < 0.05 ). Conclusion. Dexmedetomidine combined with lumbar anesthesia or combined lumbar epidural anesthesia for women in cesarean section has more clinical benefits and better safety.

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“…In a study by Ferrarezi et al, there was no significant difference in the movement block level and the anesthesia block level between different groups receiving fentanyl and bupivacaine ( p > 0.05) [ 16 ]. This study is not in line with ours, which can result from the difference in drug dose and surgery type.…”

Section: Discussionmentioning

confidence: 99%

“…It is highly lipid-soluble and binds to proteins. Fentanyl and its derivatives have pharmacological effects on µ-opioid receptors [ 16 ]. Respiratory disturbance is the most common complication of fentanyl.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Intrathecal Bupivacaine Plus Dextrose 5% and Fentanyl Compared with Bupivacaine Alone on the Onset and Duration of Analgesia in Patients Undergoing Lower-Limb Orthopedic Surgery

Sabertanha

¹

,

Makhmalbaf

²

,

Bayati

³

et al. 2023

Advances in Orthopedics

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Introduction. This study aimed to compare the effect of intrathecal bupivacaine plus dextrose 5% and fentanyl with bupivacaine alone on the onset and duration of analgesia in patients undergoing lower-limb orthopedic surgery. Materials and Methods. A total of 40 patients eligible for lower-limb surgery were divided into two groups by simple randomization: the control group which received only bupivacaine and the intervention group which received bupivacaine plus dextrose 5% and fentanyl. Anesthesia was induced by the spinal method. The visual analog scale (VAS) was used to assess the patients’ pain; hemodynamic status (systolic and diastolic blood pressure and the heart rate) and oxygen saturation were also monitored. Results. There was a significant difference between groups in the type of lower-limb movement at the L1 anesthesia level, the sensory block level at time zero after surgery, the type of backward movement at time zero after surgery, and the analgesic dose received ( p < 0.05 ). Fifteen and 30 minutes after the start of surgery, mean systolic blood pressure, and 45 and 60 minutes after the start of surgery, systolic and diastolic blood pressure and the heart rate were significantly lower in the control group than in the intervention group ( p < 0.05 ). The VAS score was significantly lower in the intervention group than in the control group at 6 and 24 hours after surgery ( p < 0.05 ). Systolic and diastolic blood pressure at time zero, systolic blood pressure at hour 6, and diastolic blood pressure at hour 24 after surgery were significantly lower in the control group than in the intervention group ( p < 0.05 ). Conclusion. The mean duration of anesthesia and analgesia was significantly longer in patients receiving bupivacaine plus fentanyl than in those receiving bupivacaine alone. However, concerning hemodynamic parameters, it cannot be concluded that the bupivacaine plus fentanyl receiving group was generally superior to the bupivacaine receiving group.

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“…Moreover, maintaining patent airways, ease of ventilation, and reduced cardiovascular complications are advantages reported with the use of propofol as GA for CS delivery in many other countries [2,7,[15][16][17]. The same is equally true for the use of bupivacaine in CS delivery which showed excellent safety records [18,19]. However, in this context, it was cautioned that in the absence of a medical indication, elective CS delivery might be associated with higher risks of asthma and allergic rhinitis in children [20].…”

Section: Discussionmentioning

confidence: 99%

The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

Karam

¹

,

Mohammad

²

2022

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Background: Limited information is available on anesthetics that are preferred or used by anesthesiologists for cesarean section (CS) delivery in Kurdistan region, Iraq. This study aims to document general or regional anesthesia use in elective CS deliveries in four major hospitals in Duhok province, Northern Iraq. Methods: A retrospective cross-sectional study was conducted from February 2019 to February 2020. The general and regional anesthetics types were recorded for each CS delivery case within the selected hospitals. Any adjuvants and medications used with the anesthetics were also recorded. Univariate and bivariate analyses were undertaken. The statistically significant was considered at less than 0.05. Results: A total of 3420 elective CS deliveries were reported. The mean age ± SD of the pregnant women was 29.6 ± 5.8 years. The anesthetics used in the four hospitals were propofol as a general anesthetic (53.0%) and bupivacaine as a spinal anesthetic (47.0%). The combination of propofol and bupivacaine was used only in 0.3%. The three most frequently and concurrently used adjuvants and medications with propofol or bupivacaine were metoclopramide (90.0%), dexamethasone (80.0%), and ephedrine (73.0%). Conclusion: Propofol and bupivacaine were the general and spinal anesthesia of choice, respectively, for elective CS delivery in Duhok province, northern Iraq. Some adjuvants and medications were supplemented to improve the quality of anesthesia and the outcome of CS delivery.

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Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial

Cited by 13 publications

References 31 publications

The Anesthetic Effect and Safety of Dexmedetomidine in Cesarean Section: A Meta-Analysis

The Anesthetic Effect and Safety of Dexmedetomidine in Cesarean Section: A Meta-Analysis

The Effect of Intrathecal Bupivacaine Plus Dextrose 5% and Fentanyl Compared with Bupivacaine Alone on the Onset and Duration of Analgesia in Patients Undergoing Lower-Limb Orthopedic Surgery

The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

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