A comparative study between intrathecal fentanyl and intrathecal buprenorphine as adjuvants to 0.5% hyperbaric bupivacaine in females undergoing lower segment caesarean section under spinal anesthesia: a randomized and double blinded study

Authors

  • Brati Mukhopadhyay Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Sanasam S. Singh Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Niroo . Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Subu Kobing Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Antony Xavier Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Vigneshwaravibhava K. Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241237

Keywords:

Buprenorphine, Fentanyl, Hyperbaric bupivacaine, Intrathecal, Spinal anesthesia

Abstract

Background: Double blinded study involving intrathecal hyperbaric bupivacaine (1.5 ml) with adjuvants as Fentanyl and Buprenorphine

Methods: Sixty-six females posted for lower segment caesarean section under spinal anesthesia were randomized into two groups-A and B. Group A received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (75 µg) of Buprenorphine. Group B received 1.5 ml of hyperbaric Bupivacaine and 0.5 ml (25µg) of Fentanyl. Sensory blockade, motor blockade and duration of analgesia were evaluated. Randomization was done using randomization.com program with GraphPad Quick Cals. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 28 software.

Results: There is no statistical difference in the demographic profiles of both groups. Duration of analgesia(minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.

Conclusions: A significant drop in mean arterial pressure in both groups from preoperative values throughout surgery, (p<0.05) with the exception of MAP at 50 minutes in B (p=0.139). A significant increase in heart rate at 2 and 4 minutes in group A when compared with baseline HR (p<0.05). In group B, a significant increase only at 2 minutes post spinal anesthesia, p=0.002. Forty-three patients had hypotension (28 vs. 15), p=0.008. Nausea is higher in Group A than B (26 vs. 4). The difference in sensory level of blockade is statistically insignificant, p=0.62. The difference in time of onset of motor blockade of Bromage score 1 was statistically insignificant, p=0.093. Duration of analgesia (minutes) in group A=255.37±34.63 and in group B=175.43±23.58 with p<0.001.

References

Kehlet H. Wilmore DW, Brennan M, Harken A. Postoperative pain care of the surgical patient. New York: Scientific American Inc.; 1988:63;121-5.

Tucker AP, Mezzetesta J, Nadsen R, Goodchild CS. Intrathecal midazolam II: combination with intrathecalFentanyl for labour pain. Anesth Analg. 2004;98:1521-7.

Fisher SP, Bader AM, Sweitzer B. Perioperative evaluation, In: Miller RD, eds. Miller’s Anesthesia 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010:1002.

Belzarena SD. Clinical effects of intrathecally administered Fentanyl in patients undergoing caesarean section. Anesth Analg. 1992;74:653-7.

SittaramaneS, Dhakshinamoorthy M. A comparative study of the effects of Fentanyl 25mcg with Bupivacaine 0.5% versus Buprenorphine 60 mcg with bupivacaine 0.5% in Spinal Anesthesia for elective Caesarean section. Indian J Anaesth. 2002; 46:469-72

World Health organization model list of essential medicines. Available at: https://www.who.int. Accessed on 20 November 2023.

Hamilton R. Tarascon Pocket Pharmacopeia 2015 Deluxe Lab-Coat Edition. USA: Bartlett learning; 2015.

Lexicomp. Available at: https://en.wikipedia.org/ wiki/Bupivacaine. Accessed on 20 November 2023.

Miller RD. Basics of Anesthesia. USA: Churchill Livingstone; 2010.

Hussain N, Brull R, Sheehy BT, Kushelev M, Essandoh MK, Abdallah FW. The mornings after periarticular liposomal bupivacaine infiltration does not improve analgesic outcomes beyond 24 hours following total knee arthroplasty: a systematic review and meta-analysis. Reg Anesth Pain Med. 2021; 46(1):61-72.

Medicines. Available at: https://www.accessdata. fda.gov/drugsatfda_docs/appletter2021/204803Orig1s0 00ltr.pdf. Accessed on 20 November 2023.

Surgical pain reduction. Available at: www.prne wswire.com/news-releases/durect-corporation-announces-us-fda-approval-of-posimir-for-post-surgical-pain-reduction-for-up-to-72-hours-following-arthroscopic-subacromial-decompression-301220159.html. Accessed on 20 November 2023.

Chan GA, Hudetz AG. The mechanical antihyperalgesic effect of intrathecally administered MPV-2426, a novel alpha2 agonist, in a rat model of postoperative pain. Anesthesiology. 2000;92:1740-5.

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Published

2024-04-30

How to Cite

Mukhopadhyay, B., Singh, S. S., ., N., Kobing, S., Xavier, A., & K., V. (2024). A comparative study between intrathecal fentanyl and intrathecal buprenorphine as adjuvants to 0.5% hyperbaric bupivacaine in females undergoing lower segment caesarean section under spinal anesthesia: a randomized and double blinded study. International Journal of Research in Medical Sciences, 12(5), 1529–1534. https://doi.org/10.18203/2320-6012.ijrms20241237

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Original Research Articles