Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

Abstract

BackgroundPotentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section.MethodsStudy was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain.ResultsOnset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl.ConclusionSpinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

Postoperative Analgesic Effect of Intrathecal Neostgmine Added to Bupivacaine for Adult Patients Undergoing Lower Limb Orthopedic Surgery

“…Studies suggest that neostigmine is an effective adjuvant to prolong the duration of the subarachnoid block and spinal analgesia with better hemodynamic stability [23] due to synergism between intrathecal neostigmine with local anesthetic agents [11]. The demographic characteristics (age, sex, weight, height), duration of surgery and ASA status were not statistically significant between the groups which was supported by many studies, p>0.05 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…There was an institution based prospective cohort study design conducted from January 1 to b. Exclusion criteria: Spinal anesthesia using local anesthetics other than bupivacaine, patient refusal, sedation, American society of Anesthesiologist (ASA) class III& IV, and communication failure [15][16][17].…”

Comparison of clonidine and fentanyl as an adjuvant to bupivacaine in unilateral spinal anaesthesia

“…This proves that by adding fentanyl the depth of spinal anaesthesia can be achieved at much lower doses of bupivacaine. 15 In our study, 25 (83.3%) patients in group BC and 27 (90%) patients in group BF achieved successful unilateral block. The difference was not statistically significant between two groups (p> 0.05).…”

Intrathecal Butorphanol: An Effective Option for Post Operative Pain Relief in Caesarean Patients

“…Morphine contributes little to the quality of surgical analgesia due to its pharmacodynamic characteristics, such as slow onset of action and prolonged duration. The isolated use of hyperbaric bupivacaine in the subarachnoid space requires higher doses (12-15 mg) to prevent visceral pain, nausea, and vomiting resulting from peritoneal traction occurring in this type of procedure 11 . However, the major factor triggering the incidence of hypotension associated with spinal anesthesia (50% to 85%) in cesarean section is the local anesthetic dosage, along with other factors such as oxytocin infusion and those involved in cephalad spread of local anesthetics in cerebrospinal fluid 12 .…”