A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections

Goyal, Ayesha; Shankaranarayan, P; Ganapathi, P

doi:10.4103/0259-1162.150169

Cited by 15 publications

(4 citation statements)

References 28 publications

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“…These drugs have rapid onset, moderate duration of action, and low affinity to expand to the fourth vertebrae, and thus they are associated with a decreased risk of respiratory depression ( 21 ). Regardless of the wide use of opioids (6.25 - 50 mcg of fentanyl and 2.5 - 7.5 mcg of sufentanil) in combination with hyperbaric bupivacaine for Cesarean section, there is no consensus on the optimum dosage of fentanyl and sufentanil ( 3 , 5 - 7 , 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section

et al. 2017

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BackgroundSpinal anesthesia is the method of choice for most elective and emergency Cesarean sections. To increase the duration of anesthesia and improve the quality of analgesia during and after surgery, intrathecal opioids, as adjuvant drugs, are used in combination with local anesthetics.MethodsThis was a double-blind clinical trial performed on 99 patients. Women were divided into 3 groups of fentanyl, sufentanil, and placebo. For fentanyl group, 12.5 mg of bupivacaine and 25 micrograms of fentanyl; for sufentanil group, 12.5 mg of bupivacaine and 2.5 micrograms of sufentanil; and for placebo group, 12.5 mg of bupivacaine and a half mL of normal saline were injected in subarachnoid space. The sensory and motor block, hemodynamic status (mean blood pressure and heart rate), and probable complications were assessed.ResultsThere was no significant difference between the groups in demographic characteristics. Durations of analgesia were, respectively, 314 ± 42.95, 312.5 ± 34.44, and 116.1 ± 42.24 minutes in the fentanyl, sufentanil, and placebo groups (P = 0.0001). Duration of sensory and motor block was higher in fentanyl and sufentanil groups compared with the placebo group. The highest duration of sensory and motor block was noted in sufentanil group (P = 0.0001). No significant difference was found between the groups in the hemodynamic parameters (P > 0.05). The frequency of itching in the fentanyl group was higher than sufentanil and placebo groups (P = 0.003). Also, shivering was higher in the placebo group compared with other groups (P = 0.036).ConclusionsAccording to the results, adding 25 microgram fentanyl or 2.5 microgram sufentanil to intrathecal bupivacaine increased the duration of analgesia and provided hemodynamic stability with no major complication. As administering intrathecal fentanyl had a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, it seems that it is a preferred additive for Cesarean section surgery.

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Section: Discussionmentioning

confidence: 99%

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section

et al. 2017

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“…The local anaesthetic dose used was similar to that used by other authors in likewise studies. 14,15 Selection of ideal vasopressor for management of post-spinal hypotension is a matter of debate. Systematic reviews and meta-analysis of clinical trials demonstrated that phenylephrine and ephedrine were both effective in preventing postspinal hypotension.…”

Section: Resultsmentioning

confidence: 99%

Hypotension after spinal anaesthesia is not always the rule in parturients undergoing caesarean section

Hosny

Ahmed

Elfawy

et al. 2020

Sri Lankan J Anaesthesiol

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Background General anaesthesia is a real challenge for the anaesthetist when anaesthetizing obstetric patients due its well-known complications of difficult intubation and thereby increasing morbidity and mortality of pregnant women. These risks can be easily avoided by regional anaesthesia. Spinal anaesthesia is frequently associated with hypotension which can have detrimental effects both on the mother and the neonate. Prophylactic phenylephrine administration had been widely practiced to prevent post-spinal hypotension during caesarean section. The goal of this study is to prove and determine that it is not always necessary to use a vasoconstrictor to avoid hypotension after spinal anesthesia for parturients undergoing caesarean section. Methods We enrolled 100 patients in this randomized controlled study who were having elective caesarean delivery. Spinal anaesthesia was performed under aseptic conditions. Immediately following spinal blockade, patients were randomly allocated to receive either a single bolus of phenylephrine 100μg in a volume of 10 ml, or equivalent volume of normal saline 0.9%. Incidence of post-spinal hypotension was used as the primary outcome. Maternal haemodynamic parameters, intraoperative nausea and vomiting, the need for phenylephrine or glycopyrrolate administration, neonatal Apgar score at 1, 5 minutes, and base excess (BE) value of the neonatal umbilical venous blood were all recorded and reflected the secondary outcome Results There was no significant difference regarding the incidence of post-spinal hypotension in phenylephrine and placebo group. There was no difference in neonatal Apgar score at 1, 5 minutes, and base excess in both groups. Conclusion The present study had demonstrated that it is not always necessary to provide a vasoconstrictor to avoid hypotension that results from spinal anaesthesia in caesarean sections.

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“…Table 3 shows that 9 mg of bupivacaine resulted in a non-significant difference (p=0.987) in shivering between groups; however, the other doses resulted in a significant difference, with 10, 11, 12, and 13 mg doses exhibiting considerably higher shivering. The combination of 15 g of fentanyl and 1.8 mL of 0.5% bupivacaine (9 mg) was found to be an excellent dose combination for spinal anesthesia during cesarean section [14].…”

Section: Discussionmentioning

confidence: 96%

Fentanyl Versus Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study

Hasan,

Haji Qadir,

Mohammed

2023

Cureus

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Background and purpose: The incidence of postoperative shivering (PS) following intrathecal anesthesia is a common complication, with potential negative impacts on patient outcomes. This study aims to evaluate the effectiveness of intrathecal fentanyl versus intravenous ondansetron in preventing post-spinal anesthesia shivering in cesarean section patients.Experimental approach: A randomized controlled trial was conducted from July 2021 to April 2023, involving pregnant women scheduled for cesarean section under intrathecal anesthesia. The participants were divided into three groups: group F received intrathecal fentanyl (15 μg) with spinal anesthesia, while group O received intravenous ondansetron (8 mg) added to the usual saline solution. The control group (group C) received only intravenous fluid before spinal anesthesia and intrathecal bupivacaine without fentanyl. Shivering occurrences were observed and recorded during the procedure.Key results: The incidence of shivering was significantly lower in the fentanyl and ondansetron groups compared to the control group (p=0.0123). Both intrathecal fentanyl and intravenous ondansetron administration showed effectiveness in reducing shivering during spinal anesthesia. Conclusion:The administration of intrathecal fentanyl and intravenous ondansetron significantly reduced the occurrence of shivering during spinal anesthesia in cesarean section patients. This study contributes to advancing knowledge in the field by providing evidence of the preventative effects of these medications on post-spinal anesthesia shivering.

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A randomized clinical study comparing spinal anesthesia with isobaric levobupivacaine with fentanyl and hyperbaric bupivacaine with fentanyl in elective cesarean sections

Cited by 15 publications

References 28 publications

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section

Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section

Hypotension after spinal anaesthesia is not always the rule in parturients undergoing caesarean section

Fentanyl Versus Ondansetron for Shivering Prevention in Cesarean Section: A Comparative Study

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