Intraoperative and Postoperative Analgesic Efficacy and Adverse Effects of Intrathecal Opioids in Patients Undergoing Cesarean Section with Spinal Anesthesia: A Qualitative and Quantitative Systematic Review of Randomized Controlled Trials

Dahl, Jørgen B.; Jeppesen, Inge S.; Jørgensen, Henrik; Wetterslev, Jørn; Møiniche, S.

doi:10.1097/00132586-200010000-00032

Cited by 110 publications

(162 citation statements)

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“…In this study, we used morphine (100 µg), a dose often recommended for subarachnoid space application in cesarean section, combined with hyperbaric bupivacaine with or without other adjuvants. At this dosage, the incidence of late adverse effects is lower and does not affect the quality of postoperative analgesia 6,[19][20][21][22][23][24][25] . Due to morphine side effects and slow onset of action, liposoluble opioids (fentanyl and sufentanil) are used intrathecally in combination with local anesthetics for cesarean section.…”

Section: Discussionmentioning

confidence: 96%

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

Braga¹,

Frias²,

Braga³

et al. 2012

Rev. Bras. Anestesiol.

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Summary: Braga AA, Frias JAF, Braga FS, Potério GB, Hirata ES, Torres NA -Spinal Anesthesia for Cesarean Section. Use of Hyperbaric Bupivacaine (10 mg) Combined with Different Adjuvants. Background and objectives:Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section.

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Section: Discussionmentioning

confidence: 96%

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

Braga¹,

Frias²,

Braga³

et al. 2012

Rev. Bras. Anestesiol.

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“…Previous studies have shown that patients who had undergo cesarean section under spinal anesthesia, benefit from simultaneous administration of local anesthetics and opiates because of increased ease of surgery [22] , significant increase in duration of spinal anesthesia [23] and lesser need for sedatives and analgesia post operatively [24] . The findings of the present study confirm the results of other studies for example Shahriari et al [25] showed that adding 15 µg fentanyl to 80 mg lidocaine intrathecally increased the duration of anesthesia and quality of analgesia during spinal anesthesia in women who undergo cesarean section.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Three Different Doses of Intrathecal Fentanyl for Prevention of Shivering in Lower Limb Orthopedic Surgeries: A Randomized Double-Blind Controlled Trial

Safavi¹

2016

JAS

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. Shivering, along with pain, nausea and vomiting are cases of discomfort and dissatisfaction in patients undergoing spinal anesthesia [9] . The combination of lipophilic opioids with hyperbaric bupivacaine during spinal anesthesia provides reduced latency, longer duration of anesthesia and better quality of anesthesia [10] . Another known effect of intrathecal opioids is prevention and treatment AbstractBackground: Fentanyl has been used to prevent shivering in spinal anesthesia but still the effects of different doses have not been appropriately specified. The aim of this study was to assess the effect of 10 µg, 20 µg and 30 µg intrathecal fentanyl on prevention of shivering during and after lower limb orthopedic surgeries under spinal anesthesia. Materials and Methods:One hundred and twenty patients undergoing elective orthopedic surgery under spinal anesthesia were enrolled in this clinical trial. Subjects were randomly divided to four groups; Group P received 3 cc bupivacaine 0.5% plus normal saline intrathecally; Group A10 received 10 µg fentanyl plus 3 cc bupivacaine 0.5% intrathecally; Group B20 received 20 μg fentanyl plus 3 cc bupivacaine 0.5% intrathecally; and Group C30 received 30 μg fentanyl plus 3 cc bupivacaine 0.5% intrathecally. Shivering and the complications were recorded. Results: Shivering intensity was different between 4 groups (P = 0.014). There was no moderate, severe and very severe shivering seen in Group C30 but there was 16.7% moderate, 10% sever, and 6.7% very severe shivering seen in Group P. The total incidence of shivering after spinal anesthesia in Groups A10, Group B20, Group C30 and Group P were 53.5%, 26.7% , 6.7% and 63.3% respectively and there was statistically significant difference between 4 group in this regard (P < 0.001). Conclusion: Intrathecal bupivacaine combined with 30 μg fentanyl was superior to using 10 µg or 20 μg fentanyl for prevention of shivering during lower extremity orthopedic surgery.

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“…While late onset respiratory depression was once feared after neuraxial morphine, with appropriate monitoring guidelines, neuraxial morphine is a safe, effective and easily used method for providing excellent analgesia after Cesarean delivery. [55][56][57] Nonsteroidal anti-inflammatory drugs (NSAIDs) were used by 59% of anesthesiologists (73% UBAs vs 46% CBAs). The NSAIDs improve analgesia and allow a smaller dose of morphine to be used, decreasing the side effects.…”

Section: Analgesia After Cesarean Deliverymentioning

confidence: 99%

Obstetric anesthesia practice in Canada

Breen

McNeil

Dierenfield

2000

Can J Anesth/J Can Anesth

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Purpose: To describe obstetric anesthesia in Canada as practiced in 1997: to identify practices at variance with the literature and the opinions of experts: and to identify questions for future research.Methods: In 1997, a detailed postal questionnaire asking about the practice of obstetric anesthesia was mailed to all 1,539 specialist anesthesiologist members of the Canadian Anaesthetists' Society residing in Canada. Nonresponders were mailed a second questionnaire three months later.Results: There were 865 completed questionnaires returned for analysis (56.2%). Of these, 522 anesthesiologists practiced obstetric anesthesia (60.3%). The data were subdivided into those from anesthesiologists with a full or part-time university based practice (40.1%) and those from a community based practice (59.9%). University based and community-based anesthesiologists have very similar patterns of practice. Specific areas where anesthesia practice was different from current recommendations included: (1) information provided when obtaining consent for labour epidural analgesia, (2) use of opioids and local anesthetics for initiation of epidural analgesia, (3) use of coagulation testing in preeclampsia, (4) the common use of cutting spinal needles, (5) use of neuraxial morphine and nonsteroidal anti-inflammatory agents after Cesarean deliveries, (6) optimal treatment of neuraxial opioid side effects, (7) when to insert an endotracheal tube for general anesthesia after delivery, and (8) withdrawing epidural catheters through epidural needles.Conclusions: This survey presents reference data on the practice of obstetric anesthesia in Canada in 1997. Anesthesiologists with university affiliation have very similar practices to those without university affiliations.Objectif: Décrire l'anesthésie obstétricale pratiquée au Canada en 1997; identifier les pratiques qui diffèrent des pratiques documentées et des opinions d'experts et proposer des sujets de recherches ultérieures.Méthode : En 1997, un questionnaire détaillé sur la pratique de l'anesthésie obstétricale a été posté aux 1 539 anesthésiologistes membres de la Société canadienne des anesthésiologistes résidant au Canada. Trois mois plus tard, un second questionnaire a été posté à ceux qui n'avaient pas encore répondu.Résultats : Il y a eu 865 questionnaires remplis et analysés (56,2 %). De ce nombre, 522 provenaient d'anesthé-siologistes pratiquant l'anesthésie obstétricale (60,3 %). Les données ont été subdivisées selon le lieu de pratique, en milieu universitaire à temps complet ou partiel (40,1 %) ou en d'autres centres (59,9 %). Les modèles de pratique étaient très similaires. Certaines activités spécifiques différaient des recommandations courantes : 1) l'information fournie pour obtenir le consentement à l'analgésie épidurale pendant le travail, 2) l'usage d'opioïdes et d'anesthésiques locaux pour amorcer l'analgésie épidurale, 3) l'utilisation d'épreuve de coagulation en préé-clampsie, 4) l'usage courant d'aiguilles rachidiennes tranchantes, 5) l'administration neuraxiale...

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Intraoperative and Postoperative Analgesic Efficacy and Adverse Effects of Intrathecal Opioids in Patients Undergoing Cesarean Section with Spinal Anesthesia: A Qualitative and Quantitative Systematic Review of Randomized Controlled Trials

Cited by 110 publications

References 0 publications

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

Raquianestesia em operação cesariana. Emprego da associação de bupivacaína hiperbárica (10 mg) a diferentes adjuvantes

The Efficacy of Three Different Doses of Intrathecal Fentanyl for Prevention of Shivering in Lower Limb Orthopedic Surgeries: A Randomized Double-Blind Controlled Trial

Obstetric anesthesia practice in Canada

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