Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

Jaishri Bogra,Pratima Srivastava,Namita Arora

doi:10.1186/1471-2253-5-5

Jaishri Bogra, Pratima Srivastava + Show 1 more

Open Access

https://doi.org/10.1186/1471-2253-5-5

Copy DOI

Abstract

BackgroundPotentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section.MethodsStudy was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain.ResultsOnset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl.ConclusionSpinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

Highlights

Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known
This study aims to monitor the effect of intrathecal fentanyl + bupivacaine on reduction of higher blocks incidence simultaneously improving the quality and avoiding the complications of higher doses of local anesthetics used in spinal anesthesia in cesarean section
In the first group of 60 parturients we tried to find the optimal dose of intrathecal bupivacaine, which was not associated with visceral pain

Summary

Introduction

Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. Spinal anesthesia is the preferred means for cesarean section, being simple to perform, economical and produces rapid onset of anesthesia and complete muscle relaxation. It carries high efficiency, involves less drug doses, minimal neonatal depression, awake mother and lesser incidences of aspiration pneumonitis. Involves less drug doses, minimal neonatal depression, awake mother and lesser incidences of aspiration pneumonitis It produces a fixed duration of anesthesia, postdural puncture, headache, hypotension and lesser control of block height [1]. With higher doses of hyperbaric bupivacaine, incidence of intraoperative visceral pain associated with higher blocks [4] is reduced [3]

Objectives

Methods

Results

Discussion

Conclusion