Low Dose Bupivacaine plus Fentanyl in Subarachnoid Block for Caesarean Section

Abstract

Background: Spinal anaesthesia induced hypotension, a common problem during caesarean section, is associated with maternal nausea and vomiting and the risk of neonatal acidosis. Low dose local anaesthetic combined with opioids spinal anaesthesia better preserves maternal haemodynamic stability, resulting in equally efficacious anaesthesia.Objectives: To investigate whether this synergistic action could be used to provide effective anaesthesia while preventing hypotension during caesarean operation.Materials and method: This prospective study included 60 pregnant mothers scheduled for caesarean operation who were then divided into two groups (thirty in each). Group-A received a spinal injection of 12.5 mg of standardized 0.5% hyperbaric bupivacaine and group-B received 8 mg of 0.5% hyperbaric bupivacaine with 20 ?gm fentanyl. Hypotension was defined as the systolic blood pressure drops below 90 mm of Hg or a decrease of systolic blood pressure 25% from pre anaesthesia level and hypotension was treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of anaesthesia and postoperative analgesia were evaluated.Results: The mean time required to reach peak sensory level was earlier in group-B than group-A and was statistically significant (p<0.05). The decrease in systolic blood pressure in group-A was significantly more than group-B (p<0.05) and vasopressor requirement was also significantly more in group-A compared to group-B (p<0.05). Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly early in group-B (p<0.05). Duration of motor recovery in group-B was significantly earlier (p<0.05). The duration of effective analgesia was significantly more in group-B (p<0.05).Conclusion: Low dose Bupivacaine with fentanyl provided excellent intraoperative sensory and motor blockade, haemodynamic stability, and effective postoperative analgesia for caesarean delivery.Delta Med Col J. Jan 2016 4(1): 24-30

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

“…Incidence of hypotension was reported in all included studies. [123567891220] Assessment of reduction in mean systolic and diastolic blood pressure was reported in five studies. [123512]…”

“…Incidence was reported either separately as nausea, vomiting in two trials[13] or combined nausea/vomiting in seven studies. [567891220]…”

“…The majority of trials reported an appropriate method of randomization. [123567820] There was a large variety of working hypotheses and primary outcomes. In 7 reports, the principal aim of the study was to test whether improved analgesia with fewer adverse effects could be achieved with the combination of a small dose of an opioid with a reduced dose of local anesthesia.…”

“…Ringer's lactate solution was most commonly used for preloading, in the range of 500–1500 ml. Hypotension was managed with ephedrine as a sole drug in five studies[15679] and mephentermine was used in one study. [3] Bradycardia (defined as a heart rate <45–50 min/min) was managed with IV atropine in three studies.…”

“…Spinal anesthesia is the most common techniques of regional anesthesia for cesarean section with minimal maternal and neonatal complications as compared to general anesthesia which is associated with difficult airway and risk of aspiration. [1234] However, hypotension during spinal anesthesia for cesarean section is the most common complication associated with nausea and vomiting, altered mental status and risk of aspiration. [1456789]…”