Postoperative Analgesia In Cesarean Section Research Articles

Effect of pre-emptive intravenous paracetamol, magnesium sulfate, and lignocaine on hemodynamic variables during perioperative period in pre-eclampsia patients scheduled for lower segment cesarean section under general anesthesia: A prospective randomized study

Background: Hemodynamic alterations during general anesthesia with endotracheal intubation are due to stimulation of the sympathetic nervous system and catecholamine release. Therefore, it is important to attenuate these responses in pre-eclampsia patients who are already under stress. Aims and Objectives: The present study aimed to evaluate the combined efficacy of paracetamol, magnesium sulfate, and lignocaine in attenuating hemodynamic responses during intubation and perioperative period. Materials and Methods: Eighty ASA II pre-eclampsia patients were randomly divided into two groups. Group PLM received intravenous infusion of paracetamol (1 g) and magnesium sulfate (30 mg/kg) in 100 ml normal saline and IV bolus Inj. lignocaine (1.5 mg/kg) 15 min before induction. Group C received only IV infusion of 100 ml normal saline. Pulse rate (PR), blood pressure (BP), and oxygen saturation were measured at various time intervals up to 40 min of delivery of baby and in up to 240 min in post-operative period. Post-operative visual analog score (VAS) and the time for first rescue analgesia (TRA I) were recorded. Results: Demographic and baseline hemodynamic parameters were comparable in both groups (P>0.05). Changes in PR and BP during laryngoscopy, intubation, and perioperative period were significantly lesser in Group PLM as compared to Group C (P<0.05). The post-operative VAS score was significantly lower whereas TRA I was significantly longer in Group PLM than in Group C at all measuring times (P<0.05). Conclusion: Combination of paracetamol, magnesium sulfate, and lignocaine attenuates hemodynamic responses during laryngoscopy, intubation, and perioperative period along with prolonged post-operative analgesia in cesarean section under general anesthesia in pre-eclampsia patients.

Analgesic Efficacy of Dexamethasone and Dexmedetomidine as an Adjuvant to 2% Lignocaine Adrenaline and 0.5% Bupivacaine in Transversus Abdominis Plane Block after Caesarean Delivery

Introduction: The ultrasound-guided Transversus Abdominis Plane (TAP) block is an analgesic technique which involves injection of a local anesthetic between the internal oblique abdominal and the transversus abdominis muscle planes. It provides analgesia to the cranial branches of T10-L1 nerve roots. It has been a practice to provide analgesia in patients following various surgical procedures including the gynecological procedures like hysterectomy and caesarean section. Aim: To assess the analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine in TAP block following caesarean delivery. Materials and Methods: This was a cross-sectional study conducted at Konaseema Institute of Medical Sciences and Research Foundation (KIMS&RF), Amalapuram, Andhra Pradesh, India for a period of one year from January 2021 to December 2021. One hundred patients with an American Society of Anaesthesiologists (ASA) physical scores of I-II, who underwent caesarean section under the Pfannenstiel incision method under subarachnoid anaesthesia with 0.5% heavy bupivacaine, were enrolled in the study. Group I consisted of patients that received an ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 20 mcg dexmedetomidine. Group II included patients who received ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine adrenaline, and 8 mg dexamethasone. The Electrocardiogram (ECG) recordings and blood pressure were recorded during the block in each patient. This approach enabled a more precise analgesic approach for each individual patient. The patients were assessed for pain up to 12 hours of surgery based on a Visual Analog Scale (VAS), where 0 represented no pain and 10 represented ‘the worst pain ever possible. Results: The patients who received ultrasound-guided TAP block with dexmedetomidine were significantly less on-demand of tramadol (p-value=0.005) and had significantly lower VAS scores at 3 hours (p-value=0,000014), 6 hours (p=0.015) and 12 hours (p-value=0.006), postoperatively. Conclusion: This study proved that dexmedetomidine was more effective when compared to dexamethasone, when added as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine. Ultrasound guided TAP block was a safe and effective postoperative analgesia in cesarean section.

Comments on published article: Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

Comments on published article: Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

Intrathecal Nalbuphine versus Intrathecal fentanyl as adjuvant to 0.5% bupivacaine for caesarian section surgery under subarachnoid block

Abstract Background One of the main objectives of anesthesia is to relieve the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. Aim of the Work To compare the post-operative analgesic effect of intrathecal-nalbuphine and fentanyl as adjuvant to bupivacaine during cesarean delivery. The secondary aim is to compare side effects between using nalbuphine and fentanyl as adjuvants to bupivacaine. Patients and Methods After Approval is obtained from the research Medical Ethical Committee of Faculty of Medicine, Ain Shams University. The study was conducted on 60 patients that were randomly selected. Randomly divided into 2 groups 30 patients each. Group F which received fentanyl as adjuvant while group N received nalbuphine as adjuvant. Results The addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the age, height, weight, and duration of operation, maximum sensory level, and maximum motor blockade level. The duration of the postoperative analgesia was prolonged with Nalbuphine group in comparison to the fentanyl group, the results were highly significant. Conclusion We concluded that either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 µg) combined with Bupivacaine improves intraoperative analgesia and prolongs early post-operative analgesia in cesarean section. There was no significant difference with regard to: Peak sensory block level, Maximum motor block level, systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate.

Low-cost techniques for bilateral intermittent transversus abdominis plane block using intravenous cannula following cesarean section

Transversus abdominis plane (TAP) block was developed as part of multimodal postoperative analgesia for cesarean section (CS) parturient. While continuous TAP block could provide satisfactory analgesia, the cost of the standard perineural catheters may limit its routine application. We present case reports of novel utilization of intravenous (IV) cannula as an alternative to the standard perineural catheters for postoperative intermittent TAP block. The results showed the feasibility and beneficial effect of IV cannula-facilitated TAP block in providing opioid-sparing postoperative acute pain management in CS parturient with minimal complication regarding its off-label application.

Comparison between subcutaneous ketamine with intramuscular pethidine versus intramuscular pethidine for post-operative analgesia after cesarean section

Abstract Background Cesarean section is one of the most common operations. Women undergoing cesarean delivery should achieve adequate postoperative pain relief because of different factors related to the operation complications as well as maternal and neonatal well-being. Immobility due to inadequate pain control could result in thrombo-embolic events, inappropriate neonatal care and delay in discharge which consequently increase the cost of this common procedure both for patients and health care system. Objective to investigate the efficacy of adding subcutaneous ketamine for postoperative analgesia in cesarean section and comparing it to using intramuscular pethidine only regarding opioid requirements and pain level. Patients and Methods The present study was carried out on two groups of women (each group consists of 25) after undergoing cesarean section under spinal anesthesia in Ain Shams University Hospitals and Helwan University Hospitals. Group A patients were given three doses of subcutaneous ketamine (0.9 mg/kg) at post-operative care unit (PACU), 12 and 24 hours after the operation with intramuscular pethidine (50mg) given when patients’ numerical pain score exceeded 5. Group B patients were given three doses of placebo at same intervals as group A and were given intramuscular pethidine (50mg) when NRS score exceeded 5. Results There was significant decrease in pain scores between two groups PACU, 12 and 24 hours postoperative with no significant change in the rest of the study. There was highly significant increase in the time to first pethidine demand in group A than B. There was highly significant decrease in total dose of pethidine given (in group A than in B. Conclusion Subcutaneous ketamine with a dose of (0.9mg/kg) can be used in reducing pain in postoperative period after CS with minimal side effects. The addition of SC ketamine to the pethidine appear to cause more pain control and decrease the total dose of pethidine given in post-operative period.

Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study.

Background and Aims:Erector spinae plane (ESP) block is an interfascial plane block given at the paraspinal region and provides effective visceral and somatic analgesia. Transversus abdominis plane (TAP) block is also an interfascial block that provides adequate somatic pain control. We conducted this study to compare the analgesic efficacy of ESP and TAP blocks with ropivacaine for 48 h after the cesarean section.Material and Methods:Sixty patients scheduled for elective cesarean section under spinal anesthesia, randomly divided into ESP block (n = 30) or TAP block (n = 30) groups. After completion of surgery, ultrasound-guided ESP or TAP block was given using 0.2% ropivacaine (0.2 ml/kg on either side). Postoperatively visual analogue scale (VAS) score and analgesic requirement of each patient was assessed at regular interval for 48 h by a blinded investigator. Statistical analysis was done using SPSS version 21. Student's t-test and Chi-square test were used for demographic and other data.Results:ESP block provided prolonged analgesia compared to the TAP block, andthe mean time to first rescue analgesia was 43.53 h and 12.07 h, respectively (P < 0.001). The requirement for total analgesic was also significantly less in the ESP group compared to the TAP group (P < 0.001).Conclusion:ESP block provided prolonged analgesia with a significant decrease in analgesic requirement compared to TAP block and can be used as a standard technique for post-cesarean analgesia.

Anterior approach of abdominal field block at linea semilunaris: A surgically assisted novel technique for postoperative analgesia in cesarean section.

Context:Post Caesarean pain is described as moderate to severe. Although advances in the new analgesics techniques, no current standard exists for optimizing and managing. Taking into consideration of acute post Caesarean pain, this novel technique of surgically assisted anterior abdominal field block at linea semilunaris have proved considerable analgesic potential along with multimodal analgesia.Aims:Although advances have been made in the understanding of the pathophysiology and in the development of new analgesics, patients still suffer from moderate-to-severe post-Cesarean pain. Taking into consideration the consequences of pain, this anterior approach to abdominal field block technique was performed to minimize acute pain experienced during post-Cesarean section.Settings and Design:Prospective observational study design.Materials and Methods:In the present study, a total of 120 parturients undergoing cesarean section (CS), after closure of uterine incision were included. We intraoperatively, under all asepsis, performed surgically assisted abdominal field block at linea semilunaris, by bilaterally injecting 20 mL 0.25% bupivacaine on each side, in addition to standard analgesic 100 mg diclofenac suppository. Each patient was assessed at 0, 4, 8, 12, and 24 h after surgery, by an independent observer for pain using NRS 0–10 and the time of the first demand for analgesic diclofenac paracetamol and its side effects.Statistical Analysis Used:The entire data is statistically analyzed using Statistical Package for Social Sciences (SPSS ver. 21.0, IBM Corporation, USA) for MS Windows. The categorical variables were compared using Wilcoxon's signed-rank test.Results:Of the total 120 patients, it is worth noting that none of the patients had severe or worst pain. The percentage of patients who did not require analgesia were (96.7%) at 4 h, (81.7%) at 8 h, (77.5%) at 12 h, and (90.8%) at 24 h. The mean analgesic consumption of paracetamol diclofenac on 4, 8, 12, 16, and 24 h after CS was significantly less. No patient required opioid supplementation. Patient satisfaction was high and was early ambulated.Conclusions:There is considerable potential for anterior approach abdominal field block, (linea semilunaris block) to comprise an effective component of a multimodal regimen for post-Cesarean section analgesia and is easy to perform within limited resources.

The Analgesic Effects of Intrathecal Morphine in Comparison With Ultrasound-Guided Transversus Abdominis Plane Block After Caesarean Section: A Randomised Controlled Trial at a Ugandan Regional Referral Hospital

(Anaesthesia. 2019;74:167–173) Worldwide, cesarean section is the most frequently performed major surgery. However, most research regarding anesthesia and postoperative analgesia for cesarean section has been performed in high-income countries that have extensive health care resources. In comparison, low-income and middle-income countries have markedly fewer resources for health care in general and postoperative nursing care specifically. This study was performed to compare analgesic outcomes after cesarean section. At a hospital in Southwestern Uganda where this study was undertaken, most of the basic postoperative nursing care after cesarean section is provided by family or friends of the patient. The current study was performed to compare outcomes when intrathecal morphine or transversus abdominis plane (TAP) block was used to provide postcesarean pain control in a resource-limited setting.

Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in cesarean section: A prospective, randomized, controlled clinical trial

Study objectiveCesarean Delivery (CD) is a commonly performed obstetric procedure. Adding a regional anesthesia technique to multimodal analgesia in CD, may improve the quality of postoperative analgesia. In this study we evaluated the efficacy of Transversalis Fascia Plane Block (TFPB) for postoperative analgesia management in CD. DesignBlinded, prospective, randomized study. SettingPostoperative recovery room & ward, tertiary university hospital, Istanbul, Turkey, PatientsSeventy-five patients (ASA II-III) scheduled to undergo Cesarean delivery were recruited. Following exclusion, 70 patients were randomized into two equal groups (block and control group). InterventionsStandard multimodal analgesia (routine paracetamol and tramadol PCA in addition to diclophenac sodium as rescue analgesia) was performed in Group C while TFPB block was also performed in the intervention (TFPB) group. MeasurementsThe primary outcome was tramadol consumption within the first 24 h. The secondary outcome was Numeric Rating Scale (NRS) scores during rest and movement/coughing. Main resultsTramadol consumption in the first 24 h was 175 ± 72.32 mg in the control and 101.42 ± 51.45 mg in the TFPB group (p < 0.05). NRS was lower in Group TFPB during the first 3 h and at the 12th hour. There was no difference in NRS scores at other hours. ConclusionBilateral ultrasound guided TFPB leads to effective analgesia and a decrease in analgesia requirement in first 24 h in patients undergoing CD.

Comparison of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: A retrospective propensity match study.

Effective and adequate post-operative analgesia for cesarean section is in demand due to increasing rates of cesarean deliveries, and may help promote recovery, ambulation and breastfeeding. Local nerve block has been applied as post-operative analgesia for maternal patients receiving cesarean section; specifically, lateral abdominal transversus abdominis plane block (TAPB) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance have been proven to be effective. The present study aimed to compare the analgesic effect of TAPB and IHINB in maternal females undergoing cesarean section. Propensity-matched females who received cesarean section (n=124) were retrospectively enrolled and divided into the TAPB group (n=62) and the IHINB group (n=62) according to their post-operative analgesia treatment. All of the patients have been given spinal-epidural anesthesia during the operation, while they received either TAPB or IHINB for post-operative analgesia. Demographic and clinical data were collected and compared, including time to first morphine request, cumulative morphine consumption, visual analogue scale (VAS) score and adverse events. Due to propensity matching, there was no significant difference between the two groups in their baseline characteristics (all P>0.05). The log-rank test indicated no significant difference in the Kaplan-Meier curves for the time to first morphine request between the two groups (P=0.575). The VAS score and cumulative morphine consumption at 6 and 12 h was similar between the two groups (all P>0.05). However, these two parameters were significantly lower in the IHINB group at 24 and 48 h (P<0.001). Uni- and multivariate logistic regression analysis indicated that the method of block was not an independent influencing factor regarding postoperative pain relief (P=0.628). There was also no difference between the two groups in adverse events of analgesia (all P>0.05). In conclusion, the present study demonstrated that TAPB and IHINB achieved a comparably satisfactory analgesic effect after cesarean section. However, the analgesic effect of IHINB was better than that of TAPB at the later stages.

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Intrathecal Hyperbaric Bupivacaine with Varying Doses of Buprenorphine for Postoperative Analgesia after Cesarean Section: A Comparative Study.

Background:Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia.Aim:The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section.Setting and Design:Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block.Materials and Methods:Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any.Statistical Analysis:Unpaired t-test and Chi-square test were used.Results:Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed.Conclusion:Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.

The application of a new approach to transversus abdominis plane block for postoperative analgesia after cesarean section

Objective To observe the effect of postoperative analgesia for cesarean section with a new approach to transversus abdominis plane block. Methods 40 ASA physical statusⅠtoⅡpatients undergoing cesarean section firstly were rucruited. All the patients were randomly divided into the two groups,20 cases in each group.A standard subarachnoid block was used. Group A:TAP block was performed at the end of surgery by piercing the transversus abdominis muscle from inside the abdominal wall at the midaxillary line at the level of the umbilicus with a 22-gauge blunt needle.The patients were assigned to receive 20m L of 0.298%ropivacaine on each side of the abdominal wall.Group B:the patients were also assigned to receive normal saline. Sufentanil was used for postoperative analgesia by PICA.Each patient was assessed at 2,4,8,24 hours postoperatively using a visual analog scale,the dosage of analgesic drug and the adverse reactions. Results Compared with group B,group A had significantly lower pain scores at 2,4 hours using a visual analog scale(P 0.05). The cumulative sufentanil requirement of group A was also significantly lower at all time points(P<0.01). The incidence of sedation of the two groups were also significant differernces,eg.nausea and vomiting(15%/25%),itchy skin(5%/20%),dizziness(0/ 10%)(P<0.05). Conclusion This new approach to transversus abdominis plane block provides effective postoperative analgesia after cesarean section. Key words: Transversus abdominis plane block; Cesarean section; Postoperative analgesia

Infiltración con bupivacaína de la incisión de Pfannenstiel para la analgesia pos cesárea

SUMMARY Aim: To compare the analgesic effectiveness of Pfannenstiel incision infiltration with bupivacaine over a placebo for post-operative analgesia in cesarean section in pregnants attending at the Hospital Dr. Adolfo Pons in Maracaibo, Zulia state, Venezuela. Methods: A comparative and applied research, with quasiexperimental, case-control, contemporary and field design, which included 60 pregnant women scheduled for elective cesarean section, divided randomly into two groups matched for Pfannestiel incision infiltration with 30 mL Bupivacaine 0.25% (75 mg) or saline solution. Pain intensity was assessed by visual analog scale (VAS). Results: In terms of pain intensity at rest and in motion, were found highly significant differences in favor of the group receiving the incisional infiltration with bupivacaine during the first six hours after surgery (p<0.001); not later than 8 hours after surgery where in all measurements, were found no significant differences between the two tested groups. Similarly, these patients had higher pain free time, surpassing the 4 hours (251 ± 14 minutes vs. 220 ± 11 minutes; p<0.001), lower analgesic requirements (199.37 ± 0.15

A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

BackgroundAdding intrathecal opioids to intrathecal local anesthetics to decrease their doses and provide hemodynamic stability are major goals during spinal anesthesia in cesarean section. Different opioids were used to select the one with the longest duration of analgesia and the least side effects. In this study, intrathecal nalbuphine was compared with intrathecal fentanyl as an adjuvant to hyperbaric bupivacaine in cesarean section.Patients and methodsSixty female patients of ASA grades I and II presented for elective cesarean deliveries with spinal anesthesia were randomly allocated to 2 equal groups; Group F: 30 patients received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group N: 30 patients received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg). The onset of sensory and complete motor blockade, time of sensory blockade, duration of analgesia and motor blockade, fetal Apgar score, visual analog scale score, oxygen saturation, adverse effects and hemodynamic parameters were recorded intra-operatively and up to 4 h post-operatively. The effective analgesic time was recorded.ResultsThe onset of complete motor block was significantly more rapid in fentanyl group than in nalbuphine group. The duration of post-operative analgesia was more prolonged in nalbuphine group but the difference was insignificant. No significant difference was found between both groups as regards the duration of sensory block, motor block, duration of analgesia, fetal Apgar score, visual analog scale score, hemodynamic parameters and oxygen saturation. Adverse effects were less common in nalbuphine group but the difference was insignificant.ConclusionEither intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

Addition of Intrathecal Fentanyl or Meperidine to Lidocaine and Epinephrine for Spinal Anesthesia in Elective Cesarean Delivery

Background:A common and useful approach to pain management is administration of neuraxial opioids.Objectives:Whether addition of fentanyl or meperidine to lidocaine and epinephrine for spinal anesthesia in elective cesarean delivery has any effects on duration of postoperative pain.Patients and Methods:This was a clinical trial, conducted on 195 pregnant women candidates for elective cesarean section. All patients were in ASA classes I, and II aged 17-45 years, and were randomly allocated to three groups named as meperidine (P), fentanyl (F), and placebo (S). In the three groups (P, F, and S), 25 mg meperidine, 25 µg fentanyl and 0.5 mL saline with lidocaine and epinephrine were injected into the subarachnoid space for spinal anesthesia, respectively. Perioperative complications and Apgar scores were recorded. Duration of analgesia was measured from the end of operation for 24 hours by using VAS. The first VAS≥4 was recorded as the end of the painless period. Characteristics of sensory and motor block were assessed. Statistical analysis was performed with SPSS software.Results:The mean duration of analgesia with meperidine, fentanyl or placebo were 9.46 ± 0.6, 6.27 ± 0.45, 2.06 ± 0.13 hours, respectively (P < 0.0001). There was significant difference between the group P and the other groups. Patients on meperidine had faster, longer and higher sensory block (P < 0.0001) and faster and longer motor block (P < 0.0001). Frequency of sedation in the group F was more than the others (P < 0.026). There was no difference in Apgar scores between the three groups (P < 0.45).Conclusions:Addition of meperidine or fentanyl to lidocaine and epinephrine solution increases the duration of postoperative analgesia in cesarean section. Meperidine is a recommended adjuvant according to longer duration of analgesia and lower complications.