DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162891

Comparison of intrathecal sufentanil and hyperbaric bupivacaine with intrathecal hyperbaric bupivacaine for caesarean section

Shweta Pravin Mhambrey, Shital S. Ahire, Sambharan Nayak

Abstract


Background: Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia without any adverse effects to the mother and neonate. In the present study we compare the effects of intrathecal sufentanil 5 µg and 8 mg of 0.5% hyperbaric bupivacaine with intrathecal 10 mg of 0.5%

hyperbaric bupivacaine for caesarean section.

Methods: This study was performed in a 60 pregnant patients undergoing elective LSCS under spinal anaesthesia in a randomized, prospective double blind comparative method in Lokmanya Tilak Municipal General Hospital after taking approval from hospital ethics committee. After fulfilling requirements of inclusion criteria patients were randomly divided into 2 groups of 30 each. Study group (BS) received intrathecal sufentanil 5 µg with 8 mg of 0.5% hyperbaric bupivacaine and the control group (B) received intrathecal 0.5% hyperbaric bupivacaine 10 mg. Pre, intra and postoperative investigations were made accordingly.

Results: No significant differences were observed among demographic parameters like age, weight, height and duration of surgery (p>0.05). The results were statistically significant (p<0.05) when the two groups were compared for the sensory blockade and motor blockade and the time to first analgesic requirement was significantly (p<0.05) prolonged in group BS as compared to group B. Both the groups showed decrease in pulse rate as compared to the baseline in the intra-operative and postoperative period. A significant (p<0.05) fall in the systolic blood pressure in B group was observed compared to BS group from 4 min to 75. None of the patients in either group developed respiratory rate <10 per minute and fall in oxygen saturation throughout the observation period. The sedation scores of the both groups were comparable and are statistically significant (p<0.05) with each other.

Conclusions: A reduced dose of 0.5% hyperbaric bupivacaine (8 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for cesarean section with better hemodynamic stability and low incidence of minor side effects as compared to 10 mg hyperbaric bupivacaine.

 


Keywords


Lower segment cesarean section, Intrathecal sufentanil, Hyperbaric bupivacaine, Spinal anesthesia

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References


Angelo DR, Smiley RM, Riley, Segal S. The serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2014;120:1505-12.

Dharmalingam TK, Ahmad Zainuddin NA. Survey on maternal satisfaction in receiving spinal anaesthesia for caesarean section. Malays J Med Sci. 2013;20:51-4.

Aiono-Le TL, Butwick AJ, Carvalho B. A survey of perioperative anesthetics practices for cesarean delivery. Anesthesiol Res Pract. 2009;2009:1-7.

Butterworth J. Physiology of spinal anesthesia: what are the implications for management?. Reg Anesth Pain Med. 1998;23:370-3.

Vyas N, Sahu DK, Parampill R. Comparative Study of Intrathecal Sufentanil Bupivacaine Versus Intrathecal Bupivacaine in Patients Undergoing Elective Cesarean Section. J Anaesthesiol Clin Pharmacol. 2010;26(4):488-92.

Lu JK, Schafer PG, Gardner TL, Pace NL, Zhang S, Niu S, et al. The dose-response pharmacology of intrathecal sufentanil in female volunteers. Anaesth analg. 1997;85:372-9.

Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg. 1997;85(3):560-5.

Olofsson C, Nygards EB, Bjersten AB, Hessling A. Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients. Acta Anaesthesiol Scand. 2004;48(10):1240-4.

Sundnes KO, Vaagenes P, Skretting P, Lind B, Edstrom HH. Spinal analgesia with hyperbaric bupivacaine: effects of volume of solution. Br J Anaesth. 1982;54(1):69-74.

Axelsson KH, Edstrom HH, Sundberg AE, Widman GB. Spinal anaesthesia with hyperbaric 0.5% bupivacaine: effects of volume. Acta Anaesthesiol Scand. 1982;26(5):439-45.

Fournier R, Van Gessel E, Weber A, Gamulin Z. A comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement. Anesth Analg. 2000;90(4):918-22.

Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg. 1997;85(6):1288-93.

Asehnoune K, Larousse E, Tadie JM, Minville V, Droupy S, Benhamou D. Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia. Anesth Analg. 2005;101(5): 1512-5.

Demiraran Y, Ozdemir I, Kocam B, Yucel O. Intrathecal sufentanil (1.5µg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy. Journal of anaesthesia. 2006;20(4):274-8.

Hansdottir V, Hedner T, Woestenborghs R, Nordberg G. The CSF and plasma pharmacokinetics of sufentanil after intrathecal administration. Anesthesiology. 1991;74(2):264-9.