Evaluation of adjunctive analgesia with intrathecal fentanyl along with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section
Keywords:Adjunctive analgesia, Fentanyl with bupivacaine, Intrathecal analgesia, Lower segment caesarean section
Background: Cesarean section (CS) is one of the most common surgical procedures in female patients. Authors aimed to evaluate the postoperative analgesic efficacy of adding intrathecal fentanyl to bupivacaine, and its effect on the onset and duration of spinal anesthesia along with its effect on mother and neonate.
Methods: Study was performed on 60 cesarean section parturients divided into two groups. Group F received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml fentanyl (20 µg), and Group B received 2 ml of 0.5% hyperbaric bupivacaine (10 mg) plus 0.4 ml of normal saline. The parameters taken into consideration were pain scores, analgesic requirement, hemodynamic stability and side effects.
Results: It was found that duration of sensory block was prolonged in fentanyl group (111 minutes vs 86 minutes, p<0.001). Duration of effective analgesia (174.36 minutes vs 127.81; p value <0.001) were also found to be prolonged in Group F with requirement of fewer postoperative analgesics (1.02 vs 2.76, p=0.03). There was not much difference in the occurrence of side effects in both the groups.
Conclusions: Addition of fentanyl to intrathecal bupivacaine for cesarean section increases the duration of postoperative analgesia without increasing maternal or neonatal side effects.
Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005 Dec;5(1):1-6.
Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth. 2009;103:750-4.
Biswas BN, Rudra A, Bose BK, Nath S, Chakraborty S, Bhattacharjee S. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early postoperative period. Indian J Anaesth. 2002;46:469-72.
Gauchan S, Thapa C, Prasai A, Pyakurel K, Joshi I, Tulachan J. Effects of intrathecal fentanyl as an adjunct to hyperbaric bupivacaine in spinal anesthesia for elective caesarean section. Nepal Med Coll J. 2014;16:5‑8.
Yun SH, Song SW, Park JC. Beneficial effects of the addition of intrathecal fentanyl to bupivacaine for spinal anesthesia in cesarean section. Anesth Pain Med. 2017;12:233-9
Nayagam HA, Singh NR, Singh HS. A prospective randomised double blind study of intrathecal fentanyl and dexmedetomidine added to low dose bupivacaine for spinal anesthesia for lower abdominal surgeries. Indian J Anaesth. 2014;58:430-5.
Ali MA, Ismail S, Sohaib M, Aman A. A double-blind randomized control trial to compare the effect of varying doses of intrathecal fentanyl on clinical efficacy and side effects in parturients undergoing cesarean section.J Anaesthesiol Clin Pharmacol. 2018;34:221-6
Abate SM, Belihu AE. Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis. Saudi J Anaesth. 2019;13:340-51.
Weigl W, Bierylo A, Wielgus M, et al. Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section: a randomized controlled study. Medicine. 2016;95:e3827.
Weigl W, Bierylo A, Wielgus M, Krzemień-Wiczyńska S, Szymusik I, Kolacz M, et al. Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination. Int J Obstet Anesth 1997;6:43-8.