Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery

Ün, Canan; Ornek, Dilsen; Kilci, Oya; Donmez, Ferah; Gamlı, Mehmet; Dikmen, Bayazıt

doi:10.4103/1119-3077.110154

Cited by 9 publications

(8 citation statements)

References 26 publications

(27 reference statements)

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“…Other complications are often correlated with hypotension (5). Thus, the incidence of other complications also decreased in Test group (Table 3), which is consistent with previous studies (5). Theoretically, hypotension may decrease blood flow volume of umbilical artery, and induce hyoxemia and acidosis in fetus (4).…”

Section: Height Based Dosing Algorithm Of Bupivacaine Induced a Low I...supporting

confidence: 90%

“…According to anatomical structure, for cesarean section, it is recommended that the highest sensory block level should reach dermatome level dominated by the fourth thoracic nerve (T4) (23). However, in different studies, the highest sensory block level is required to reach T4, T5, T6, or T8 (5,14,20,(24)(25)(26). In some parturients, even though the highest sensory block level reaches T4, they still feel slight pain (23).…”

Section: Interventionmentioning

confidence: 99%

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A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

et al. 2022

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BackgroundThere is a high incidence of maternal hypotension in spinal anesthesia for cesarean section. The aim of the study is to investigate whether there is a height-based dosing algorithm of bupivacaine that provides adequate anesthesia with less maternal hypotension.MethodsThere were 2 groups of 280 parturients who did not receive prophylactic fluid preloading: Test and Conventional group. In Test group, a height based dosing algorithm was used to confirm the dose of bupivacaine in parturients without prophylactic vasopressors. In the Conventional group, a constant dose of bupivacaine was used. The complications and quality of anesthesia were evaluated.ResultsIn the Conventional group, the shorter participants had higher incidence of hypotension, faster sensory block time, and more participants with complete motor block (p = 0.030, 2.957 × 10−14, and 0.012). In the Test group, the incidence of hypotension, sensory block time, and number of participants with complete motor block did not change with height (p = 0.199, 0.617, and 0.209). The height-based dosing algorithm of bupivacaine decreased the incidence of hypotension (p = 0.004), induced lower sensory block level and less degree of motor block (p = 3.513 × 10−7 and 5.711 × 10−11). The quality of analgesia, quality of muscle relaxation, and degree of intraoperative comfort were similar in both groups (p = 0.065, 0.498, and 0.483).ConclusionsThe height influences the dose of bupivacaine in spinal anesthesia; without prophylactic fluid pre-loading and vasopressors, the height-based dosing algorithm of bupivacaine is suitable, and meets the cesarean section' requirement with less maternal hypotension.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03497364.

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Section: Height Based Dosing Algorithm Of Bupivacaine Induced a Low I...supporting

confidence: 90%

Section: Interventionmentioning

confidence: 99%

A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

et al. 2022

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“…In 2012, in a study on pregnant and non-pregnant mothers on the need for narcotic and analgesic, a significant difference was observed regarding the need for narcotic and non-narcotic analgesic in the narcotic-dependent mothers (12). Due to hyperalgesia of opioid-addicted mothers, for improving pain control and decreasing the adverse effects of local anesthetics, in this study, bupivacaine consumption was decreased and 50 µg fentanyl was used.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Bupivacaine Versus High-Dose Bupivacaine Along With Fentanyl for Spinal Anesthesia in Opioid-Dependent Mothers

Kashani

Gilani

Keshtan

et al. 2018

Int J High Risk Behav Addict

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Introduction: Spinal anesthesia is the method of choice for cesarean section. In opioid-dependent mothers, more narcotic is necessary for analgesia. In this study, low dose bupivacaine was used to reduce adverse effects, and high dose fentanyl was used to improve analgesia. Methods:This randomized double-blinded study was performed on 60 opioid-dependent pregnant females in 2 similar groups. In the high-dose bupivacaine with low-dose fentanyl (HBLF) group, 10 mg of bupivacaine and 25 µg of fentanyl, and in the low-dose bupivacaine with high-dose fentanyl (LBHF) group, 6 mg of bupivacaine and 50 µg of fentanyl were used for spinal anesthesia. The blood pressure, heart rate, itching, nausea and vomiting, Apgar score at 1 and 5 minutes, and surgeon and patient satisfaction were evaluated during the study. The sensory block onset and reverse were measured to T5 and T12, respectively. The patient's pain was assessed by a verbal analogue scale (VAS) every half an hour. The time of analgesic was determined from anesthesia injection to verbal analogue scale of > 4. The information was analyzed using the SPSS v16 software and P < 0.05 was considered significant. Results:The demographic data and pre-anesthetic hemodynamic status were similar. The blood pressure was decreased in both groups (P = 0.019), yet there was no significant difference between the 2 groups (P = 0.43). There was no difference in heart rate (P = 0.33), itching, nausea, and vomiting, Apgar score at 1 and 5 minutes, and surgeon and patients' satisfaction, (P value was 0.47, 0.54, 0.85, 0.86, 0.92, and 0.09, respectively). The block onset to T5 in the HBLF group and LBHF group was 4.4 ± 0.9 and 5.3 ± 0.9 minutes, respectively (P = 0.002). The sensory block reverse to T12 in the HBLF group and the LBHF group was 141.2 ± 28.9 and 122.3 ± 24.5 minutes, respectively (P = 0.03). Also, the time of the first analgesic in the HBLF group and the LBHF group was 248.2 ± 31.4 and 282.1 ± 28.6 minutes, respectively (P = 0.02).Conclusions: There was no difference between low-dose and high-dose narcotic groups in complications and satisfaction. In the opioid-addicted mothers, the sensory block at high-dose bupivacaine (10 mg) and low-dose fentanyl (25 µg) was faster and longer. On the other hand, the duration of analgesia in the low-dose bupivacaine (6 mg) and high-dose fentanyl (50 µg) was higher.

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“…Fentanyl, a lipophilic opioid, has rapid onset of action after intrathecal administration. [23581215] After intrathecal administration, fentanyl diffuses into epidural space and subsequently into the plasma, suggesting that it acts not only through spinal opioid receptors but also systemically. Delayed respiratory depression is less likely associated with fentanyl, as it does not reach to 4 th ventricle in sufficient concentrations.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

Abate

Belihu

2019

Saudi J Anaesth

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Hypotension during spinal Anesthesia is the most common complication with maternal and neonatal morbidity and mortality. Low dose bupivacaine with intrathecal fentanyl is recommended as strategy to prevent spinal Anesthesia induced hypotension and related complications. The aim of this systemic review is to evaluate the efficacy of low dose bupivacaine with Intrathecal fentanyl on the improvement of maternal and neonatal outcomes compared to conventional dose bupivacaine among mothers who undergone cesarean section. We conducted a systemic search of the electronic databases of Pubmed, Medline, LILACS and others with PICO strategy for randomized controlled clinical trials comparing low dose bupivacaine with fentanyl and conventional dose bupivacaine for cesarean section. Joanna Briggs Institute (JBI) standardized data extraction form was used for data extraction and finally entered into Review Manager for data synthesis. Ten Randomized trials (552) were included in this review. Incidence of hypotension was less likely in mothers who received low dose bupivacaine with Fentanyl as compared to those with conventional dose of bupivacaine alone (RR = 0.43, 95% confidence interval (CI) 0.12-0.47, ten trials, 552 participants). The review revealed that Low dose bupivacaine combined with intrathecal Fentanyl decrease incidence of hypotension.

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Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery

Abstract: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects.

Cited by 9 publications

References 26 publications

A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial

Low-Dose Bupivacaine Versus High-Dose Bupivacaine Along With Fentanyl for Spinal Anesthesia in Opioid-Dependent Mothers

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

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