Fentanyl with low dose bupivacaine (isobaric and hyperbaric) and levobupivacaine for combined spinal-epidural technique in cesarean section

Abstract

To compare the hemodynamic and motor block effects of fentanyl combined with low doses of isobaric and hyperbaric bupivacaine and isobaric levobupivacaine in Caesarean operations with Combined Spinal-Epidural Anesthesia (CSEA) method. The aim of study is to use levobupivacaine and bupivacaine more effectively and comfortably in caesarean sections. Methods: A hundred and sixty pregnant women were randomly divided into four groups (n=40). A total volume of 1.8 mL containing 9 mg of plain bupivacaine (Group A), 5 mg of plain bupivacaine plus 40 µg fentanyl (Group B), 5 mg of plain levobupivacaine plus 40 µg fentanyl (Group C) and 5mg of hyperbaric bupivacaine plus 40 µg fentanyl (Group D) were applied. Results: Hemodynamic parameters and level of sensory block did not differ among the groups. Time to reach T4 sensory block level was 6 ± 1 min for Group A, 4 ± 1 min for Group B and C, and 7.5±2.5 min for Group D (P= 0.045). Bromage scores were: 110.5 ± 10.1 min, 90.1 ±11.1 min, and 85.1 ± 10.2 min for Group A, B and D, respectively. The patients in Group C had no motor block. Conclusions: Combining fentanyl (40 µg) with low dose (5 mg) isobaric and hyperbaric bupivacaine, and isobaric levobupivacaine provided sufficient anesthesia. Sensory block with no motor block was provided by adding fentanyl, especially to levobupivacaine, which eases perioperative period and delivers patient comfort.