A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section

Abstract

Context:Hormonal and mechanical factors make obstetric patients need strict dose calculations of local anesthetics intrathecally for spinal anesthesia. Any greater dose of local anesthetics can cause hemodynamic instability, maternal morbidity and any lesser dose can produce inadequate block. Hence, we hypothesized in our study that by using low dose of bupivacaine with fentanyl can maintain stable hemodynamics and provide better analgesia.Aim:The aim was to compare the hemodynamics and duration of analgesia using a low dose (7.5 mg) bupivacaine fentanyl mixture to a conventional dose (10 mg) of hyperbaric bupivacaine for cesarean section.Settings and Design:Double-blinded, randomized, controlled prospective study was conducted at a tertiary academic hospital from 2008 to 2011.Materials and Methods:Fifty singleton parturient, scheduled for elective caesarean section were randomly allocated into two groups. Study group (group-S) received a combination of 25 μg fentanyl and 7.5 mg of hyperbaric bupivacaine, whereas the control group (group-C) received 10 mg of hyperbaric bupivacaine. Maternal hemodynamics, sensory and motor block, duration of analgesia and the Apgar score of the newborn were compared between the groups.Statistical Analysis Used:Observational descriptive statistics, statistical package for social sciences (SPSS Inc. Released 2006, SPSS for Windows, Version 15.0. Chicago), paired t-test was used as applicable.Results:The blood pressure significantly decreased with >25% fall from the baseline in group-C (98.76 ± 8.36) than in group-S (117.32 ± 12.21) with P < 0.001. The duration of effective analgesia was significantly prolonged in the study group than in the control group (P < 0.001).Conclusion:The combination of low dose bupivacaine and fentanyl in comparison to bupivacaine alone is hemodynamically stable and prolonged duration of analgesia in caesarean section.

Intrathecal Hyperbaric Ropivacaine and Hyperbaric Ropivacaine with Fentanyl in Caesarean Section: A Comparative Study

“…Singh H et al [7] conducted a study to evaluate the effect of intrathecal fentanyl on the onset and duration of hyperbaric bupivacaine-induced spinal block in adult male patients and concluded that fentanyl prolongs mean time for sensory regression upto L1 dermatome (141±37 min, p<0.05) and increased the duration of sensory block by 28% , which is in accordance with the findings of our study. This is also in agreement with Gupta K et al [9] , who compared intrathecal isobaric ropivacaine with ropivcaine -fentanyl solution and Venkata HG et al [14] , who compared intrathecal low dose (7mg) bupivacaine-fentanyl mixture with 10mg hyperbaric bupivacaine; both found fentanyl to be effective in prolonging the mean time (359.80±66.96 & 200 ± 9.1) to sensory block regression at S1 (p<0.05).…”

“…Maintenance of heart rate is one of the prominent features of opioids. After initial fall in MAP, Group B recovered earlier than Group A. Venkata HG et al [14] observed a significant decrease in blood pressure (p<0.001) in only bupivacaine group than in bupivacaine-fentanyl group and concluded that fentanyl provides better hemodynamic stability. This is also supported by Jagtap S et al [20] where better hemodynamic stability has been seen with intrathecal ropivacaine-fentanyl group.…”

Does the Reduction of the Local Anesthetic Dose Provide Surgical Anesthesia While Avoiding Maternal Hypotension in Obese Pregnant Women for C/S with Single-shot Spinal Anesthesia?

“…In the study by Venkata et al (14), hyperbaric bupivacaine together with fentanyl reached the T6 sensory level faster compared than other regimens, but the groups in that study were not classified as obese and non-obese as in our study.…”

“…Our study is not the first to show no difference in dosage between obese and non-obese patients. Norris (6) and Hartwell et al (15) also found that BMI had no effect on spinal anesthesia in women undergoing cesarean section (14). Moreover, in the study by Lee et al (8), a similar dose requirement was found for obese and non-obese patients undergoing cesarean section.…”

A Comparative Study of Intrathecal Ropivacaine-Fentanyl and Bupivacaine-Fentanyl for Lower Limb Orthopaedic Surgeries

“…Venkata HG [17] and his colleagues compared the duration of analgesia and haemodynamics using a low dose (7.5 mg) bupivacaine-fentanyl mixture with a conventional dose (10 mg) of hyperbaric bupivacaine for cesarean section. They compared between 10 mg of hyperbaric bupivacaine, and a drug combination containing 25 micrograms fentanyl and 7.5 mg of hyperbaric bupivacaine, posted for elective caesarean section.…”