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

Abstract

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.

Comparative Study of 2 Doses of Sufentanyl (2.5 Μg versus 5 Μg) in the Rachianesthsia for Cesarean Section

“…Similar results to those of this study [10,23] were found by Trik et al [24] MIGNONSIN D. et al [9] In our study, the adverse effects (nausea, vomiting) were more marked in the Gr II (p = 0.00, p = 0.04). Numerous comparative studies have proved that the existence of nausea and vomiting was due to the presence of opioids in Comparative Study of 2 Doses of Sufentanyl (2.5 Μg versus 5 Μg) in the Rachianesthsia for Cesarean Section the anesthetic solution [4,10,11,25,26,27]. These side effects achieved by adding colloids in pre-filling were opposed to ours according to Siddik et al [28].…”

“…They can thus reduce the dosage and the hemodynamic effects of local anesthetics, prolong the action time of the spinal block and finally obtain intense and prolonged postoperative analgesia. have been reported according to the type and dosage of morphine used [5,6,7,8,9,10,11].…”

“…Sufentanyl has been used in intrathecal injection for many years by teams [8,10,12]. The availability of sufentanyl in our hospital since January 2017 motivated our work.…”

The Analysis of Risk Factors to Hypotension Occurring after Caesarean Spinal Anesthesia for Parturients with Scarred Uterus

“…The result showed that the use of bupivacaine with 25 μg fentanyl or 2.5 μg sulfentanyl as intrathecal drug can increase the analgesia duration and hemodynamic stability, without causing serious complications. Therefore, this study adopted low dose of bupivacaine (9 mg) and sulfentanyl (2.5 μg) as the intrathecal drug (9) , which not only reduced the incidence of hypotension but also ensured better analgesia effect.…”

Letter to: “The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections”

“…For example, under the conditions of Wilwerth et al study, sufentanil 5μg was the opioid of choice, as compared to fentanyl in combination with hyperbaric bupivacaine in intrathecal anesthesia that was associated with the best quality of anesthesia without increased incidence of side effects ( 3 ). Furthermore, in another study, administering intrathecal hyperbaric bupivacaine plus fentanyl achieved a similar duration of analgesia like sufentanil with faster return of motor block and ambulation, and the authors preferred it as an additive for cesarean section surgery ( 4 ). In addition, Faiz et al studied the effects of adding neostigmine or magnesium sulfate to bupivacaine and concluded that magnesium sulfate is a safe and effective adjuvant to increase the onset time of motor block ( 5 ).…”