A Randomised Double-Blinded Dose Response Study of the Fentanyl with Hyperbaric Ropivacaine in Cesarean Section

Gupta A Bogra J

doi:10.4172/2155-6148.1000467

Abstract

Background: Much research work has been done to know the minimum required concentration of local anaesthetic agents, employing various adjuvants for cesarean section. The present study states that Fentanyl addition to heavy Ropivacaine reduced the dose of later, thereby its side effects related to higher doses in cesarean sections. Patients: Three groups of thirty parturient each were made randomly. Group I received 15 mg 0.6% Ropivacaine; Group II received 12 mg 0.6% Ropivacaine and 12.5 μg Fentanyl and Group III received 10 mg 0.6% Ropivacaine and 25 μg Fentanyl. Sensory and motor block properties, hemodynamics, intraoperative visceral pain, sedation, shivering, nausea and vomiting, postoperative analgesia; foetal outcomes and side effects were evaluated. ANOVA, chi-square and Mann-Whitney-U tests were used where appropriate (p<0.05). Results: Intrathecal hyperbaric Ropivacaine and its combination with Fentanyl provided effective sensory and motor block (1.73-2.1 min, p value<0.001), S2 dermatome regression time was longer in Ropivacaine- Fentanyl combination as compared to Ropivacaine alone. Umbilical venous pH and APGAR score was similar (9-9.4) in all groups. Postoperative analgesic effect (monitored as a secondary end-point) was prolonged by addition of Fentanyl; here intraoperative ephedrine requirement was significantly increased in group I (30 mg) as compared to group II (8 mg) and III (6 mg). Conclusions: S2 dermatome regression time taken as the primary end point was longer in Ropivacaine- Fentanyl combination as compared to Ropivacaine alone. Addition of 12.5 and 25 μg Fentanyl significantly reduced the dose of heavy Ropivacaine resulting in longer, complete and effective analgesia with hemodynamic stability and less side-effects. It is concluded that intrathecal hyperbaric Ropivacaine provides efficient and safe anaesthesia for cesarean section delivery and that this effect is further enhanced by the addition of Fentanyl. Hence the best effective and safe combination, as per this study is 12 mg of Ropivacaine with 12.5 μg Fentanyl (Group II).

Highlights

Spinal anaesthesia is well known safe, effective, economical, easy to perform technique which provides rapid and reliable anaesthesia with muscle relaxation for cesarean section
Addition of 12.5 and 25 μg Fentanyl significantly reduced the dose of heavy Ropivacaine resulting in longer, complete and effective analgesia with hemodynamic stability and less side-effects
It is concluded that intrathecal hyperbaric Ropivacaine provides efficient and safe anaesthesia for cesarean section delivery and that this effect is further enhanced by the addition of Fentanyl

Summary

Introduction

Spinal anaesthesia is well known safe, effective, economical, easy to perform technique which provides rapid and reliable anaesthesia with muscle relaxation for cesarean section. There has been two good studies on intrathecal Fentanyl with hyperbaric Ropivacaine they are: addition of Fentanyl 10 μg, to hyperbaric Ropivacaine 15 mg, for spinal anaesthesia increased the duration of analgesia in the early postoperative period in patients undergoing caesarean delivery [10], and the second one is about finding the lowest effective local anaesthesia effect of Ropivacaine and Bupivacaine [11], here we postulate that the addition of fentanyl to hyperbaric Ropivacaine may allow reduction of heavy dose of Ropivacaine, providing hemodynamic stability and prolonged post-operative analgesia. ANOVA, chi-square and Mann-Whitney-U tests were used where appropriate (p

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