Fentanyl For Cesarean Section Research Articles

Effect of intravenous palonosetron on hypotension induced by spinal anesthesia for cesarean section: A randomized controlled trial.

The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3-507.8 μg versus 428.0 μg [interquartile range, 305.0-507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.

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.

A Comparative Study of Intrathecal Versus Intravenous Fentanyl in Cesarean Section under Subarachnoid Block

A Comparative Study of Intrathecal Versus Intravenous Fentanyl in Cesarean Section under Subarachnoid Block

Postoperative Analgesia with Intrathecal Nalbuphine versus Intrathecal Fentanyl in Cesarean Section: A Double-Blind Randomized Comparative Study.

Background:Nalbuphine when used as adjuvant to hyperbaric bupivacaine has improved the quality of perioperative analgesia with fewer side effects. Fentanyl is a lipophilic opioid with a rapid onset following intrathecal injection. It does not cause respiratory depression and improves duration of sensory anesthesia without producing significant side effects.Aim:This study aims to compare the postoperative analgesia of intrathecal nalbuphine and fentanyl as adjuvants to bupivacaine in cesarean section.Methodology:A prospective, randomized, double-blind, and comparative study was conducted on 150 parturients of American Society of Anesthesiologists (ASA) physical status I and II of age group 20–45 years with normal coagulation profile undergoing cesarean section under spinal anesthesia. These patients were randomized into three groups with fifty patients in each group. Group I received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml nalbuphine (0.8 mg), Group II received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 μg), and Group III received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline.Results:The mean duration of effective analgesia was 259.20 ± 23.23 min in Group I, 232.70 ± 13.15 min in Group II, and 168.28 ± 7.55 min in Group III. The mean number of rescue analgesics required was significantly lower (P < 0.001) in Group I as compared to Group II and III.Conclusion:Both intrathecal nalbuphine 0.8 mg and fentanyl 20 μg are effective adjuvants to 0.5% hyperbaric bupivacaine in subarachnoid block. However, intrathecal nalbuphine prolongs postoperative analgesia maximally and may be used as an alternative to intrathecal fentanyl in cesarean section.

A Comparative Evaluation of Intrathecal Administration of Hyperbaric Bupivacaine alone and in Combination of Different Low Doses of Hyperbaric Bupivacaine with Fentanyl in Cesarean Section

A Comparative Evaluation of Intrathecal Administration of Hyperbaric Bupivacaine alone and in Combination of Different Low Doses of Hyperbaric Bupivacaine with Fentanyl in Cesarean Section

Comparative Study of Intrathecal Bupivacaine versus Bupivacaine with Fentanyl for Cesarean Section

Background: Spinal anaesthesia for cesarean section has been the preferred technique for majority of anaesthesiologist. Maternal hypotension following spinal anaesthesia remains common place in cesarean delivery. The combination of reduced dose of local anaesthetics with intrathecal opioids makes it possible to achieve adequate spinal anaesthesia with minimum hypotension. Objectives: The aim of our study was to compare the effectiveness of plain bupivacaine with low dose bupivacaine plus fentanyl with respect to sensory and motor blockade, hemodynamic changes, side effect profile and post-operative analgesia after spinal anaesthesia. Material and methods: 60 patients undergoing elective cesarean section under spinal anaesthesia were randomly allocated to two equal groups; Group B patients received 10 mg (2 mL) of 0.5% hyperbaric bupivacaine and Group B + F received 8mg (1.6 mL) of 0.5% hyperbaric bupivacaine plus 20 ug (0.4 mL) preservative free fentanyl. The clinical profile of subarachnoid block in two groups and its effect on maternal and neonatal outcome was studied. Results: The mean time required to reach peak sensory level was earlier in Group B + F. Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly earlier in Group B. Duration of motor recovery was earlier in Group B +F. Mean maximal heart rate was significantly more in Group B. Mean minimal systolic arterial pressure was significantly less in Group B compared to Group B + F. The duration of effective analgesia was significantly more in Group B + F (235.33+29.15) compared to Group B (120.33+10.98). The incidence of side effects was less in Group B + F than Group B. Conclusion: We can conclude that the addition of low dose fentanyl to 0.5% hyperbaric bupivacaine for spinal anaesthesia in cesarean section provides satisfactory sensory and motor blockade, better hemodynamic stability, less side effects and effective post-operative analgesia. Key words: Bup

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Background: Intravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except for special cases such as preeclampsia, these drugs are not recommended for parturants candidate for cesarean section because of the respiratory depression caused in the newborn. Objectives: According to rapid metabolism of remifentanil, the current study aimed to compare hemodynamic changes in preeclamptic parturants who received remifentanil and fentanyl for cesarean section under general anesthesia. Patients and Methods: This single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 ?g/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 ?g) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index were measured and compared between the two groups. Results: All hemodynamic variables increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771). Conclusions: It can be postulated that remifentanil can be used in partituents candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn.

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

BackgroundIntravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except for special cases such as preeclampsia, these drugs are not recommended for parturants candidate for cesarean section because of the respiratory depression caused in the newborn.ObjectivesAccording to rapid metabolism of remifentanil, the current study aimed to compare hemodynamic changes in preeclamptic parturants who received remifentanil and fentanyl for cesarean section under general anesthesia.Patients and MethodsThis single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 μg/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 μg) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index were measured and compared between the two groups.ResultsAll hemodynamic variables increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771).ConclusionsIt can be postulated that remifentanil can be used in partituents candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn.

Effect of Intravenous Phenylephrine or Ephedrine on the ED50 of Intrathecal Bupivacaine With Fentanyl for Cesarean Section

Effect of Intravenous Phenylephrine or Ephedrine on the ED50 of Intrathecal Bupivacaine With Fentanyl for Cesarean Section

Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for Caesarean section

Prophylactic infusion of phenylephrine to prevent hypotension at Caesarean section has been shown to decrease the rostral spread of intrathecal plain levobupivacaine and intrathecal hyperbaric bupivacaine by a median of two dermatomes compared with ephedrine. The aim of this study was to determine the median effective dose (ED50) of intrathecal bupivacaine required to achieve a block to touch at the xiphisternum in patients undergoing Caesarean section when phenylephrine or ephedrine are used to prevent hypotension. Seventy women were randomized in two groups to receive either phenylephrine at a rate of 16.6 microg min(-1) (concentration 1microg ml(-1)) or ephedrine at a rate of 1.5 mg min(-1) (concentration 90 microg ml(-1)). Patients received varying doses of hyperbaric bupivacaine with fentanyl 25 microg using a double-blinded, up-down sequential allocation design. Effective doses were defined as anaesthesia to touch with ethyl chloride spray to the xiphisternum within 20 min. The ED50 estimates of bupivacaine were similar in the two groups: 7.8 mg [95% confidence interval (CI) 6.7-8.9] with phenylephrine and 7.6 mg (95% CI 6.8-8.4) with ephedrine. Systolic blood pressure control was similar (P=0.18) with vasopressors but heart rate was higher with ephedrine (P=0.0014). Under the conditions of this study, we have shown that when phenylephrine or ephedrine were used to prevent post-spinal hypotension, the dosing requirement of hyperbaric bupivacaine was similar for intrathecal anaesthesia.

Comparison of Three Doses of Isobaric Ropivacaine Mixed with Fentanyl during Spinal Anesthesia for Cesarean Section

Background: We evaluated the appropriate dose of spinal isobaric 0.75% ropivacaine with fentanyl for cesarean section. Methods: Forty-five healthy term parturients scheduled for an elective cesarean section randomly received 14, 16, 18 mg of 0.75% isobaric ropivacaine intrathecally, which was mixed with fentanyl 20. Sensory blockade variables such as time to L1 block, max. block height, time to max block height, and time to recovery to L1 were assessed. Motor blockade variables such as time to Bromage scale 3, motor recovery time (Bromage scale 3 to 1) and muscle relaxation were assessed. We also checked side effects, and hemodynamic variables. Results: Anesthesia was successful in 57%, 80%, and 93.3% of groups I (14 mg), II (16 mg), and III (18 mg) respectively and there was no significant difference between the three groups. The time to max. sensory and motor block and level of maximum sensory block were not significantly different between the three groups. All groups showed complete motor block, and muscle relaxation was equally excellent in the three groups. Sensory and motor recovery time were not significantly different. The incidence of hypotension was more frequent in group 3 compared with group 1. The incidence of nausea was more frequent in group 3 compared with group 1, and 2. Conclusions: An intrathecal injection of 16 mg of isobaric 0.75% ropivacaine with fentanyl 20 during spinal anesthesia is suitable for an elective cesarean section.

Clinical Experiences of Balanced Anesthesia with Nalbuphine or Fentanyl in Cesarean Section

Clinical Experiences of Balanced Anesthesia with Nalbuphine or Fentanyl in Cesarean Section