Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section

Abstract

Cesarean section (CS) is one of the most common surgical procedures in female patients. We aimed to evaluate the postoperative analgesic efficacy of intrathecal fentanyl during the period of greatest postoperative analgesic demand after CS. This period was defined by detailed analysis of patient-controlled analgesia (PCA) usage.This double-blind, placebo-controlled, parallel-group randomized trial included 60 parturients who were scheduled for elective CS. Participants received spinal anesthesia with bupivacaine supplemented with normal saline (control group) or with fentanyl 25 μg (fentanyl group). To evaluate primary endpoints, we measured total pethidine consumption over the period of greatest PCA pethidine requirement. For verification of secondary endpoints, we recorded intravenous PCA requirement in other time windows, duration of effective analgesia, pain scores assessed by visual analog scale, opioid side effects, hemodynamic changes, neonatal Apgar scores, and intraoperative pain.Detailed analysis of hour-by-hour PCA opioid requirements showed that the greatest demand for analgesics among patients in the control group occurred during the first 12 hours after surgery. Patients in the fentanyl group had significantly reduced opioid consumption compared with the controls during this period and had a prolonged duration of effective analgesia. The groups were similar in visual analog scale, incidence of analgesia-related side effects (nausea/vomiting, pruritus, oversedation, and respiratory depression), and neonatal Apgar scores. Mild respiratory depression occurred in 1 patient in each group. Fewer patients experienced intraoperative pain in the fentanyl group (3% vs 23%; relative risk 6.8, 95% confidence interval 0.9–51.6).The requirement for postoperative analgesics is greatest during the first 12 hours after induction of anesthesia in patients undergoing CS. The addition of intrathecal fentanyl to spinal anesthesia is effective for intraoperative analgesia and decreases opioid consumption during the period of the highest analgesic demand after CS, without an increase in maternal or neonatal side effects. We recommend using intrathecal fentanyl for CS in medical centers not using morphine or other opioids intrathecally at present.

Neuraxial opioids as analgesia in labour, caesarean section and hysterectomy: A questionnaire survey in Sweden

“…Yet currently, the present study found that twelve units use solely lipophilic opioid adjuncts with rapid onset and shorter duration to local anaesthesia and two of the units add morphine to local anaesthetics with no addition of fentanyl or sufentanil. Intrathecal.lipophilic opioids in CS are not as effective as intrathecal morphine, they still proved to be beneficial during the period of highest analgesic demand after CS 18 .…”

“…On the other hand it could be discussed that event though intrathecal lipophilic opioids in CS are not as effective as intrathecal morphine, they still proved to be beneficial during the period of highest analgesic demand after cesarean section 4 .…”

A Comparative Study on Three Different Doses of Fentanyl with Bupivacaine in Spinal Anaesthesia in Caesarean Section

“…Recovery of sensory block was significantly longer (p<0.05) in group using 25 mcg fentanyl resulting in prolonged post-operative analgesia. 29,17 Thus, it was seen that with higher dose of fentanyl the sensory block was denser than the lower doses. These findings are consistent with the studies conducted by Sowmya et al 10 Block intensity was assessed by the degree of motor block.…”

Comparative Study of Bupivacaine With Fentanyl vs Bupivacaine With Fentanyl Plus Morphine in Spinal Anaesthesia for Lower Segment Caesarean Sections

“…There are a number of studies where Fentanyl added to Bupivacaine heavy had shown beneficial effects in terms of rapid onset, smooth maintenance & extended duration of post-operative analgesia. 10 Most of the study had employed Fentanyl in the dose of 25 µg. Intrathecal morphine was first described in 1801 and since the publication on it by Wang JK, et al, in 1979, the popularity of the intrathecal morphine has overgrown tremendously.…”