Comparison of different fentanyl doses in spinal anesthesia for caesarian delivery

Yıl 2020, Cilt: 17 Sayı: 1, 258 - 261, 31.03.2020

Fatma Kavak Akelma , Zahide Özlem Ulubay , Sengül Özmert , Betül Güven Aytaç , Galip Özmert

Öz

INTRODUCTION
We aimed to compare the clinical efficacy and characteristics of bupivacaine spinal block when combined with either 10 or 25 mcg fentanyl in spinal anesthesia for Cesarean delivery. We also sought to evaluate its effects on maternal and neonatal hemodynamics.
MATERIAL AND METHODS
American Society of Anesthesiologists (ASA) Score I-II pregnant women aged 18-45 years who received spinal anesthesia for elective Cesarean section were included in the study. Age, weight, height, weeks of gestation at delivery. Patients were divided into three groups: Patients who received hyperbaric bupivacaine alone were classified as Group I, those who received hyperbaric bupivacaine plus 10 mcg fentanyl were classified as Group II and those who received hyperbaric bupivacaine plus 25 mcg fentanyl were classified as Group III. Block characteristics, as well as hemodynamic data, were retrieved from records. Additionally, heart rate, SpO2 readings at 5- and 10- minute and 1- and 5- minute Apgar scores of the newborn were noted.
RESULTS
Demographic properties were similar among the three groups. Mean time to onset of sensory block at T10 dermatome and mean time to Modified Bromage scale 3 was significantly shorter in Group III compared to the other two groups (p<0,05). The first analgesic requirement time was found to be longer in Group II and III compared to Group I (p= 0,05). SBP and DBP values at 3-minute were significantly decreased in all three groups (p<0,05). The difference in-between the three groups, however, was not significant. One- and 5-minute Apgar scores were similar among groups. 5- and 10-minute heart rates and saturation rates of the newborns did not differ among groups. The incidence of postoperative headache, pruritus, nausea, vomiting and urinary retention was also similar among the groups.

CONCLUSION
We recommend the use of intrathecal fentanyl because it shortens the onset time of anesthesia, increases the quality of intraoperative analgesia, prolongs the duration of sensorial block and delays the onset of postoperative pain.

Anahtar Kelimeler

Spinal anesthesia, fentanyl, cesarean delivery, bupivacaine

Teşekkür

909 07-22 numarası ile yazı kabul edilmişti. İnternet sitesi yenilendiği için tekrar yükleniyor. Teşekkür ederim

Kaynakça

• 1. Wang LZ, Zhang YF, Tang BL, Yao KZ. Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section. Br J Anaesth. 2007;98(6):792-6.
• 2. Misirlioglu K, Sivrikaya G, Hanci A, Yalcinkaya A. Intrathecal low-dose levobupivacaine and bupivacaine combined with fentanyl in a randomised controlled study for caesarean section: blockade characteristics, maternal and neonatal effects. Hippokratia. 2013;17(3):262-7.
• 3. Greer KC, Terkawi AS, Tsang S, Singla P, Durieux ME, Tiouririne M. The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery. Reg Anesth Pain Med. 2017;42(5):669-73.
• 4. Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005;5(1):5.
• 5. Venkata HG, Pasupuleti S, Pabba UG, Porika S, Talari G. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi J Anaesth. 2015;9(2):122-7.
• 6. Turkmen A, Moralar DG, Ali A, Altan A. Comparison of the anesthetic effects of intrathecal levobupivacaine + fentanyl and bupivacaine + fentanyl during caesarean section. Middle East J Anaesthesiol. 2012;21(4):577-82.
• 7. Shahriari A, Khooshideh M. Intrathecal fentanyl added to lidocaine for Cesarean delivery under spinal anesthesia--a randomised clinical trial. Middle East J Anaesthesiol. 2007;19(2):397-406.
• 8. Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. Br J Anaesth. 2002;89(3):452-8.
• 9. Bozdogan Ozyilkan N, Kocum A, Sener M, Caliskan E, Tarim E, Ergenoglu P, et al. Comparison of intrathecal levobupivacaine combined with sufentanil, fentanyl, or placebo for elective caesarean section: a prospective, randomized, double-blind, controlled study. Curr Ther Res Clin Exp. 2013;75:64-70.
• 10. Demiraran Y, Ozdemir I, Kocaman B, Yucel O. Intrathecal sufentanil (1.5 microg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy. J Anesth. 2006;20(4):274-8.
• 11. Loubert C, Gagnon PO, Fernando R. Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study. J Clin Anesth. 2017;36:194-200.
• 12. Xu S, Wu H, Zhao Q, Shen X, Guo X, Wang F. The median effective volume of crystalloid in preventing hypotension in patients undergoing cesarean delivery with spinal anesthesia. Rev Bras Anestesiol. 2012;62(3):312-24.
• 13. Gunusen I, Karaman S, Sargin A, Firat V. A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean section: prospective, double-blinded study. J Anesth. 2011;25(2):205-12.
• 14. Lee YY, Muchhal K, Chan CK, Cheung AS. Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial. Eur J Anaesthesiol. 2005;22(12):899-903.
• 15. Ratcliffe FM, Evans JM. Neonatal wellbeing after elective caesarean delivery with general, spinal, and epidural anaesthesia. Eur J Anaesthesiol. 1993;10(3):175-81.
• 16. Hu L, Pan J, Zhang S, Yu J, He K, Shu S, et al. Propofol in combination with remifentanil for cesarean section: Placental transfer and effect on mothers and newborns at different induction to delivery intervals. Taiwan J Obstet Gynecol. 2017;56(4):521-6.
• 17. Mueller MD, Bruhwiler H, Schupfer GK, Luscher KP. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstet Gynecol. 1997;90(1):131-4.
• 18. Dourado AD, Filho RL, Fernandes RA, Gondim MC, Nogueira EV. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial. Braz J Anesthesiol. 2016;66(6):622-7.
• 19. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth. 2003;15(3):234-9.