Bupivacaine For Caesarean Section Research Articles

A COMPARISON OF INTRATHECAL HYPERBARIC BUPIVACAINE AND HYPERBARIC BUPIVACAINE WITH FENTANYL IN LSCS FOR POST OPERATIVE ANALGESIA

Introduction: Postoperative pain by virtue of its unique transient nature is more amenable to therapy. Spinal anaesthesia is preferred in LSCS. Intrathecal opioids to increase analgesic effect of bupivacaine during caesarean section and are used worldwide. The present study was conducted to elucidate the comparison between intrathecal bupivacaine and bupivacaine with fentanyl for postoperative analgesia. Materials and methods: 160 pregnant patients between 18 to 35 yrs of age were seleted .Group F received: Bupivacaine 0.5% with 10 microgram fentanyl and Group B received Bupivacaine 0.5 % alone. Results: Onset of sensory and motor block was comparable in both groups. Two segment regression and the duration of analgesia was signicantly prolonged in group F (360 ± 53.15 min) as compared with Group B (219.75 ± 39.29 min). There was no signicant statistical difference in the incidence of side effects in either group. Conclusion: It can be concluded that fentanyl (10 mcg) as an adjuvant to spinal bupivacaine in caesarean section reduces the dose of local anaesthetic agent and signicantly prolongs the postoperative analgesia with no signicant maternal and neonatal side effects.

Comparison of the Dexmedetomidine and Sufentanil Added to Spinal Anesthesia with Bupivacaine for Hemodynamic Stability and Postoperative Analgesia in Elective Cesarean Section Surgery: A Single-Blinded Randomized Clinical Trial

Background: Hemodynamic instability, including hypotension and bradycardia, can occur due to spinal anesthesia by bupivacaine. However, it is possible to reduce the chance of hemodynamic changes by the reduction of the dose of bupivacaine and/or the addition of adjunctive agents. Objective: This study aimed to compare the effects of the addition of intrathecal dexmedetomidine and sufentanil to spinal anesthesia with bupivacaine in elective cesarean section (CS). Methods: This prospective single-blinded randomized clinical trial with parallel groups was performed on 60 pregnant women who were candidates for elective CS in Imam Reza Hospital in Kermanshah, Iran. In addition to receiving 10 mg of hyperbaric bupivacaine 0.5%, they were randomly divided into two groups to receive intrathecal sufentanil 5 μg (30 cases) or dexmedetomidine 5 μg (30 cases). Changes in blood pressure, heart rate, and occurrence of side effects (e.g., nausea, vomiting, headache, and shivering) were recorded within 1 h after the injections. Moreover, the postoperative analgesia rate and duration (using a visual analog scale [VAS]) were recorded within the first 24 h after the completion of the CS. Headache severity (using a VAS) was also measured during the first week after CS. Results: Patients declared their satisfaction with analgesia after surgery. No significant difference was found between the two groups in terms of heart rate and systolic and diastolic blood pressure changes during the first 60 min. Similarly, no significant difference was observed between the two groups in terms of the severity of incision pain in the first 24 h after CS surgery. On days 3, 4, and 5, none of the patients in the sufentanil and bupivacaine group had headaches (VAS=0), but patients in the dexmedetomidine and bupivacaine group had some degree of headache (P=0.040). Conclusions: Based on the results, intrathecal administration of bupivacaine with either sufentanil or dexmedetomidine in CS did not have significantly different effects, except for slightly more severe headaches in the dexmedetomidine group. Therefore, no superiority of one drug over the other was observed for intrathecal administration with bupivacaine in CS.

Synergistic effect of inthrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section in Baghdad city

Background: Potentiating the effect of intrathecal local anesthetics drugs by addition of intrathecal opiods for intra-abdominal surgeries had been used lately. In this study by addition of fentanyl, we tried to minimize the dose of bupivacaine thereby reducing the side effect caused by higher doses of intrathecal bupivacaine in cesarean section, and to improve the quality of block.Methods: Study was performed on sixty patients underwent cesarean section they were divided into 6 groups as B10, B 12.5, B15 mg of bupivacaine and FB10, FB12.5, FB15 received a combination of 25 µg intrathecal fentanyl respectively, the parameter taken into consideration were visceral pain, hemodynamic stability (hypotension and bradycardia) intra operative sedation, nausea, vomiting and post-operative pain. Results: Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine fentanyl combination groups. Alone lower concentration of bupivacaine could not completely remove the visceral pain. Blood pressure declined with increasing the concentration of bupivacaine and fentanyl. The incidence of nausea and vomiting was reduced significantly while post-operative pain relief and hemodynamics stability increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in APGAR score of babies did not occur with fentanyl. Conclusions: Spinal anesthesia among the neuro axial blocks in obstetric patients’ needs strict dose calculation because minimal dose changes results in more complications and side effects Here the synergistics potentiating effects of fentanyl (an opiod) on bupivicaine (local anesthetic) in spinal anesthesia for cesarean section is presented. Fentanyl is able to reduce a dose of bupivicaine and therefore its harmful effect.

A COMPARISON BETWEEN INTRATHECAL NALBUPHINE VERSUS FENTANYL AS AN ADJUVANT WITH 0.5% HYPERBARIC BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING LOWER SEGMENT CESAREAN SECTION

Background: Subarachnoid block is the preferred anesthesia for cesarean section, being simple to perform and economical with rapid onset. This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section.
 Methods: A prospective, randomized, double?blind, and comparative study was conducted on 120 patients of American Society of Anesthesiologists (ASA) physical status I and II. These patients were randomized into three groups with fifty patients in each group. Group A received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 ?g), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline.
 Results: The mean duration of sensory block was 107.32 ± 5.36 min in Group A, 111.23 ± 4.23 min in Group B, and 85.69 ± 2.31 min in Group C. The mean duration of motor block (time required for motor block to return to Bromage’s Grade 1 from the time of onset of motor block) was 152.02 ± 3.12 min in Group A, 151.69± 2.36 min in Group B, and 122.12 ± 2.32 min in Group C.
 Conclusion: We concluded that intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section.
 Keywords: Nalbuphine, Bupivacaine, Fentanyl.

Comparative Study of Fentanyl vs Dexmedetomidine as Adjuvants to Intrathecal Bupivacaine in Cesarean Section: A Randomized, Double-Blind Clinical Trial.

PurposeEffective postoperative analgesia is essential in cesarean section. This study aimed to compare postoperative analgesia and hemodynamic changes after intrathecal use of fentanyl or dexmedetomidine combined with bupivacaine.Patients and MethodsThis study involved 110 pregnant women with ASA I and II and gestational age ≥37 weeks who were candidates for elective cesarean section. They were randomly divided into two groups of 55; Group B-D received 10 mg bupivacaine (0.5%) + 5 μg dexmedetomidine and Group B-F received 10 mg bupivacaine (0.5%) + 25 μg fentanyl, intrathecally. The onset of block, duration of analgesia, the score of pain intensity, hemodynamic changes, Apgar scores, and any adverse events were evaluated. P-value <0.05 was considered statistically significant.ResultsPatients in two groups were similar in terms of demographic characteristics and ASA classification. Duration of analgesia in the B-D group was significantly longer than B-F group (428.64±73.39 vs 273.18±61.91 min; P<0.001). The score of pain intensity during recovery time in the B-D group was significantly lower than that of B-F group (0.33±0.84 vs 0.51±0.57 min; P=0.004). The onset of block was also faster in the B-D group than B-F group (98.27±35.95 vs 110.45±37.69 seconds; P=0.036). The two groups did not show significant differences in hemodynamic changes and other variables (P>0.05).ConclusionCompared with fentanyl, it seems that adding 5 μg dexmedetomidine to bupivacaine has a better effect on postoperative pain management in cesarean section under spinal anesthesia.

Generalized Tonic-clonic Seizures Following Spinal Anesthesia Using Bupivacaine for Cesarean Section: A Case Report

Generalized Tonic-clonic Seizures Following Spinal Anesthesia Using Bupivacaine for Cesarean Section: A Case Report

The efficacy of ropivacaine and bupivacaine in the caesarean section and the effect on the vital signs and the hemodynamics of the lying-in women.

ObjectiveTo investigate the efficacy of ropivacaine and bupivacaine in caesarean section and vital signs and the hemodynamics of the lying-in women.MethodsA total of 480 lying-in women who were admitted to this hospital for treatment between December 2017 and June 2018 were enrolled into this study as the subjects, which were divided into the experiment group and the control group, with 240 subjects in each group. In the experiment group, subjects received the local anesthesia by infusion of 1.5 mL ropivacaine (0.75%), while those in the control group also took the local anesthesia by infusion of 1.5 mL bupivacaine (0.75%). Thereafter, we observed the differences in the anesthetic efficiency, vital signs and hemodynamics of the lying-in women between two groups.ResultsThe excellent and good rates of the anesthesia in two groups were 92.1% and 87.9%, showing no obvious difference; in the experiment group, the average arterial pressures and systolic pressures at 5 min and 10 min after combined spinal and epidural analgesia (CSEA) were all elevated when comparing to the control group (all P < 0.05); in the experiment group, the onset time was obviously extended, while duration of sensory and motor block and the duration of motor block were all shorter than those in the control group (all P < 0.05). During anesthesia, the incidence rate of the adverse reactions in the control group was 2.50%, significantly higher than 0.83% in the experiment group (P < 0.05).ConclusionDespite that ropivacaine and bupivacaine are efficient in anesthesia in the CSEA in the caesarean section, ropivacaine is more recommended for little influence on the hemodynamics, shorter duration of sensory block and motor block and low incidence rate of adverse reactions, which are conducive to the recovery and also safe to the patients.

Motor and sensory blocking effect of intrathecal fentanyl versus dexmedetomidine as adjuvants to bupivacaine for cesarean section

Background Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist, and its α2/α1 selectivity is eight times higher than that of clonidine. Aim The aim of this study was to determine the effect of adding dexmedetomidine and fentanyl to intrathecal bupivacaine on the onset time and duration and intensity of motor and sensory blocks for cesarean section. Patients and methods The study was carried out on 40 adult female patients who were randomly classified using closed envelope method into two equal groups, with 20 patients in each: group D patients received intrathecally 2.5 ml volume of 10 mg (2 ml) 0.5% hyperbaric bupivacaine and 10 µg dexmedetomidine in 0.5 ml (prepared by diluting 1 ml dexmedetomidine in 5 ml of normal saline), and group F patients received intrathecally 2.5 ml volume of 10 mg (2 ml) 0.5% hyperbaric bupivacaine and 20 µg fentanyl in 0.5 ml (prepared by diluting 2 ml fentanyl in 2.5 ml of normal saline). The aim was to evaluate motor and sensory block. Sensory block assessment: the onset and duration of sensory block was assessed by ice cube method, and time taken from intrathecal injection to the highest level of sensory block and sensory regression to the L1 dermatome were recorded. On achieving T7 sensory blockade level, surgery was allowed. Motor block assessment: onset and degree of motor block was assessed by Bromage scale: 0, no paralysis; 1, inability to raise extended leg; 2, inability to flex the knee; and 3, inability to flex the ankle (complete motor block). Results Sensory and motor block onset times were shorter in group D than in group F. The regression of the sensory block to S1 dermatome and Bromage 0 were longer in group D than group F. The two-dermatome regression time was longer in group D than group F. There was a statistically significant decrease in group F regarding systolic, diastolic, and mean arterial blood pressures and heart rate than group D. There was no statistically significant difference among the two groups regarding arterial oxygen saturation and respiratory rate. Neonatal outcome was normal in all groups. Conclusion Intrathecal dexmedetomidine addition to bupivacaine for spinal anesthesia synergistically increases block duration and shortens sensory and motor block onset time without any significant adverse effects.

Clinical observation on ropivacaine and bupivacaine for cesarean section in combined spinal-epidural anesthesia

Objective To compare the anesthetic effect of ropivacaine and bupivacaine in combined spinal-epidural anesthesia(CSEA) for cesarean section, and their influence on the incidence rate of supine hypotension syndrome(SHS). Methods 200 patients with cesarean section surgery in our hospital from February 2016 to July 2016 were randomly divided into observation group and control group, all of cases were given CSEA.100 patients in the observation group(the group L) were given ropivacaine in spinal anesthesia, the other 100 patients in the control group(the group B) were given bupivacane in spinal anesthesia.Recorded the relevant indicators, compared the incidence rate of SHS, the effect of anesthesia and neonatal score. Results The incidence rate of SHS of the group L was lower than the group B(χ2=9.261, P 0.05). Conclusion The application of ropivacaine in CSEA for cesarean section not only has exact anesthesia effect, but also can effectively prevent SHS without any side effects. Key words: Cesarean section; Ropivacaine; Anesthesia, combined; Supine hypotension syndrome

A prospective randomised double blind study of the comparison of two opioids- fentanyl and buprenorphine – as adjuvant to spinal bupivacaine in caesarean sections

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Opioids are first introduced as additives to spinal anaesthesia in 1979, with intrathecal morphine as forerunner. Neuraxial opioids when added to local anaesthetics prolong the duration of sensory block, improve quality of block and no unwanted sympathetic blockade leading to hypotension. This prospective randomized double blind study was undertaken to evaluate the duration of analgesia, sensory and motor blocking properties and side effects of two opioids – Fentanyl and Buprenorphine, when used as adjuvant to spinal Bupivacaine in caesarean section.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients between the age group 18-35 years belonging to ASA I and II posted for elective LSCS were randomly divided into two groups. Each group consisting of 30 patients , received either 1.8 ml 0.5% Bupivacaine with 25 mcg Fentanyl (group F) or 1.8 ml 0.5% Bupivacaine with 75 mcg buprenorphine (Group B). The onset, maximum level and duration of sensory and motor blockade and hemodynamic parameters were monitored.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Maximum height of sensory block was achieved faster in fentanyl group (i.e. 4.09±1.12 minutes compared to 4.56±1.21 minutes in buprenorphine group). Duration of analgesia was significantly prolonged in buprenorphine group. It was 317±54 minutes and 214±35 minutes respectively for buprenorphine and fentanyl groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study thus concluded that although fentanyl produce faster sensory block, duration of analgesia is longer with buprenorphine, and both the drugs do not cause significant side effects.&lt;/p&gt;

Ffficacy of Low Dose Intrathecal Fentanyl Added to Bupivacaine in Cesarean Section: An Observational Study

Ffficacy of Low Dose Intrathecal Fentanyl Added to Bupivacaine in Cesarean Section: An Observational Study

Intraoperative neurological event during cesarean section under spinal anesthesia with fentanyl and bupivacaine: Case report and review of literature

Neurological events similar to transient ischemic attack in a peripartum woman are uncommon. Cerebral complications of preeclampsia, thrombo-embolic phenomena, or high spinal can mimic such situations. Spinal anesthesia with local anesthetic and opioid is an established anesthetic technique for cesarean section. Although intrathecal opioids are safe for both the mother and fetus; some unusual complications such as dysphagia alone or associated with facial numbness, aphasia, have been reported. We report a case of transient aphonia and tingling sensation over the face without any dysphagia after intrathecal administration of bupivacaine and fentanyl for cesarean section.

Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section

Aims and Context:The objective of the present study was to evaluate the analgesic and adverse effects of intrathecal clonidine with hyperbaric bupivacaine in spinal anesthesia.Settings and Design:Randomized single blind trial.Methods:210 ASA I-II pregnant females undergoing emergency cesarean section were randomized in a single-blind fashion to one of the three groups. In group I (n=70) patients received 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. In group II (n=70) patients received intrathecal mixture of 0.5% hyperbaric bupivacaine (8 mg) and clonidine 50 μg. In group III (n=70), patients received 0.5% hyperbaric bupivacaine (10 mg) intrathecally along with 50 μg of clonidine.Statistical Analysis Used:Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test (χ2 =57.2410).Results:On adding 50 μg clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21±5.15 min. (group II) vs 146.0±4.55 min (group I), P=0.021; 95% confidence interval: 238.01-257.40, group II and 134.99-157.0 group I].Conclusions:Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief.

Cardiac Arrest Following Spinal Anaesthesia With Plain Bupivacaine for Caesarean Section

We describe cardiac arrest after plain bupivacaine spinal anaesthesia in a 28-year old woman who was admitted for an elective caesarean section. After preoperative evaluation and premedication she received a spinal anaesthesia in the L3-4 interspace with plain bupivacaine 0.5%. After being replaced in the supine position she reported difficult breathing. Radial pulse and blood pressure were no longer recordable. Cardiopulmonary resuscitation was started immediately, tracheal was intubated and the foetus delivered rapidly. After delivery of a healthy child the patient's pulse became palpable and circulation returned. The patient regained consciousness and the trachea extubated at the end of surgery. She was discharged from the ICU the next day without sequelae. In this paper the disadvantages of plain bupivacaine are discussed. Nigerian Medical Practitioner Vol. 50 (3&4) 2006: pp. 65-67

Effects of Intrathecal and I.V. Small-Dose Sufentanil on the Median Effective Dose of Intrathecal Bupivacaine for Caesarean Section

Effects of Intrathecal and I.V. Small-Dose Sufentanil on the Median Effective Dose of Intrathecal Bupivacaine for Caesarean Section

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

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.

A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section

This randomised controlled trial examines the effects of fentanyl and diamorphine, alone and in combination, as adjuncts to spinal anaesthesia for Caesarean section. Ninety-nine women undergoing elective Caesarean section with spinal anaesthesia using 0.5% hyperbaric bupivacaine were randomly allocated to receive fentanyl 15 microg (F), diamorphine 0.25 mg (D), or fentanyl 15 microg plus diamorphine 0.25 mg (FD), intrathecally. All women received morphine via a patient controlled analgesia system after surgery. There was no significant difference between the groups in time to achieve a block, discomfort, ephedrine use, nausea and vomiting, pruritus and sedation during surgery. Significant differences were observed in morphine consumption 4, 8, 12 and 24 h after surgery between both F and D groups, and F and FD groups, and also at 2 h between F and FD groups. There was a significant difference in pruritus at 4 h between the F and FD group. Our results suggest that diamorphine alone provides optimum benefits during and after surgery, when used in combination with hyperbaric bupivacaine for Caesarean section.

Comparison of the Effects of Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine for Caesarean Section

Comparison of the Effects of Intrathecal Ropivacaine, Levobupivacaine, and Bupivacaine for Caesarean Section

Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for Caesarean section under spinal anaesthesia

Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for Caesarean section under spinal anaesthesia

Ropivacaine for obstetric use

Ropivacaine is a new local anesthetic similar to bupivacaine but with a lower systemic toxicity and a greater sensory-motor separation that have been established clearly in in vitro, animal, and human studies. Although median effective-dose studies in laboring women have suggested that ropivacaine is approximately 40% less potent when compared with bupivacaine, this difference is not confirmed in obstetric studies aimed at providing adequate pain relief in all parturients. These latter studies found that equal doses of ropivacaine and bupivacaine provided similar analgesia of similar duration, suggesting equipotency with respect to sensory blockade in the obstetric population. In obstetrics, the increased safety profile makes ropivacaine a better choice than bupivacaine for cesarean section with epidural anesthesia in case of an accidental intravascular injection. The greater sensory-motor separation is advantageous in epidural labor analgesia because there are clear indications that ropivacaine is associated with a lower incidence of instrumental deliveries when compared with bupivacaine and because the reduction in motor block itself is a distinct advantage in terms of patient comfort. Based on these observations, ropivacaine is, at present, the drug of first choice in obstetrics. Copyright © 2001 by W.B. Saunders Company