Abstract
Background: Adequate pain relief is considered as a basic human right .In obstetrics patients, using low dose opioids (Morphine, Fentanyl, sufentanil) in neuraxial blockade is effective method for anaesthesia and postoperative analgesia in LSCS and nearly no danger to parturient or unborn. Subjects and Methods: Keeping in mind the difference in the baricties of commonly used hyperbaric bupivacaine and morphine, we conducted a single blind randomized controlled trial on 156 full term parturient scheduled for elective and emergency LSCS under SAB and on the technique of intrathecal administration of drug parturients were divided into 3 groups. GROUP 1 (n=52) - Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + morphine 200mcg (0.2ml) as a mixture GROUP 2 (n=52)-Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + Morphine 200mcg (0.2ml) administered after bupivacaine GROUP 3 (n=52)-Hyperbaric bupivacaine (0.5%) 9mg (1.8ml) + Morphine 200mcg (0.2ml) administered before bupivacaine. We observed for block characteristics, maternal hemodynamics and neonatal outcome. Results: In our study, duration of analgesia was clinically prolonged in all the groups. The block characteristics were comparable between the groups.These beneficial effects were not accompanied by any major hemodynamic instability or adverse effects and no untoward effect on the newborn. Conclusion: Premixed and sequential administration of IT morphine with hyperbaric bupivacaine were comparable in terms of quality of subarachnoid block maternal hemodynamic and neonatal outcome.
Highlights
Spinal anaesthesia has long been used for LSCS, but there has always been an area of interest to search for method to provide better quality of interaoprative anaesthesia and prolongation of postoperative analgesia.[1]
Patient selection was done after taking written informed consent from them. 156 healthy, full term, non laboring parturient, ASA I or ASA II with singleton, uncomplicated pregnancy planned for both elective and emergency LSCS under subarachnoid block (SAB) were involved in the study
The onset time of motor block and Bromage3 were correlated with Hussien RM.et al who discussed that, there was no significant difference on the onset of motor block between rapid and normal sequential administration of intrathecal fentanyl with hyperbaric bupivacaine (p=0.35)
Summary
Spinal anaesthesia has long been used for LSCS, but there has always been an area of interest to search for method to provide better quality of interaoprative anaesthesia and prolongation of postoperative analgesia.[1] Opioids (e.g.morphine) have synergistic effect with local anesthetic when given intrathecally[2,3] by reducing visceral pain, thereby improving the the block quality,[4] while causing reduction of LA dosages and maintaining stable hemodynamic parameters.[1] It enhances postoperatively analgesia period.[5,6] Routine practice of mixing opioid to local anaesthetic is easy but may alter the baricity and effecting spread in CSF .We planned this study with the hypothesis that depositing Local anaesthetic and opioid using separate syringes may reduce these changes and influence spread.we compared the effect of premixed (Hyperbaric bupivacaine and Morphine) and sequential administration of additive (Morphine) before and after hyperbaric bupivacaine on block characterstics and maternal and fetal outcome.
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