Intrathecal Sufentanil for Labor Analgesia Does Not Cause a Sympathectomy 

1997 ◽  
Vol 87 (4) ◽  
pp. 874-878 ◽  
Author(s):  
Edward T. Riley ◽  
Dean Walker ◽  
Catherine L. Hamilton ◽  
Sheila E. Cohen
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
Labor Analgesia ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Hyperbaric Bupivacaine ◽  
Central Temperature ◽  
Elective Cesarean ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Intrathecal sufentanil (ITS) is frequently used to provide analgesia during labor. Decreases in blood pressure and sensory changes in this circumstance suggest that ITS may have a local anesthetic effect and thus cause a sympathectomy. To determine whether ITS given to laboring women causes a sympathectomy, the authors evaluated central and lower extremity temperature changes after ITS administration. These findings were compared with those in a control group of women having spinal anesthesia with bupivacaine for elective cesarean section in whom an extensive sympathectomy was expected. Methods Twenty parturients classified as American Society of Anesthesiologists' physical status 1 or 2 had temperatures measured centrally, at the calf, and at the great toe at frequent intervals after receiving 10 microg ITS for labor analgesia (sufentanil group, n = 10), or hyperbaric bupivacaine 12 mg in their spinal anesthetic for cesarean section (bupivacaine group, n = 10). Calf-to-toe temperature indices (C-T) were calculated by subtracting toe temperature from calf temperature. A decrease in this index means that the toe had warmed compared with the calf and is an indication of vasodilation and a sympathectomy. Results There was no significant change in the C-T indices or central temperature in the sufentanil group, but the C-T indices and central temperature decreased significantly in the bupivacaine group. Conclusions The decreases in the C-T index and central temperature in the bupivacaine group indicate the presence of a sympathectomy. The lack of change in the C-T indices and central temperature in the sufentanil group indicates that no significant vasodilation occurred. Therefore, the decrease in blood pressure seen after ITS administration for labor analgesia is unlikely to be the result of a sympathectomy.

scholarly journals Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

2019 ◽  
Vol 9 (2) ◽  
pp. 79-82
Author(s):  
Bharati Devi Sharma Regmi ◽  
Gopendra Prasad Deo ◽  
Subin Shrestha ◽  
Sabita Shrestha ◽  
Renuka Tamrakar Mishra
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Elective Cesarean

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group. Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

Phenylephrine Added to Prophylactic Ephedrine Infusion during Spinal Anesthesia for Elective Cesarean Section

2001 ◽  
Vol 95 (3) ◽  
pp. 668-674 ◽  
Author(s):  
Frédéric J. Mercier ◽  
Edward T. Riley ◽  
Willard L. Frederickson ◽  
Sandrine Roger-Christoph ◽  
Dan Benhamou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
American Society ◽  
Spinal Hypotension

Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses. Results Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups. Conclusion Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.

Traditional Versus Instructing Standard Guidelines of Preoperative Fasting Times on Associated Discomforts in Patients undergoing Elective Cesarean Section: Orotta Maternity National Referral and Teaching Hospital and Sembel Hospital, Eritrea

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Michael Beraki ◽  
Yosief Yohannes ◽  
Goetz Geldner ◽  
John McDonough
Keyword(s):  
Cesarean Section ◽  
Randomized Clinical Trials ◽  
Task Force ◽  
Elective Cesarean Section ◽  
Preoperative Fasting ◽  
Fasting Time ◽  
Comparison Groups ◽  
Elective Cesarean ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractIntroduction: Preoperative fasting is vital in preventing pulmonary aspiration, regurgitation and vomiting during the induction of anesthesia. Every patient scheduled for surgery including pregnant mothers need to be on fasting for certain period of time. Women undergoing cesarean section need full energy for themselves and the fetus to overcome the stress of birth. However, fasting time in Eritrea is generally longer than is recommended by American Society of Anesthesiologists. Prolonged fasting time has undesirable effects including, nausea, vomiting, dizziness, thirst, hunger etc. Objectives: This study compared the associated discomforts between traditional versus instructing standard guidelines of fasting times among mothers undergoing elective cesarean section. Methods: A non-randomized clinical trials among 106 mothers was conducted. Two groups for comparisons in two different hospitals were selected. One group received instructions of preoperative fasting according to the American Society of Anesthesiologists Task Force guidelines and the other group followed through the traditional approaches, i.e. “nothing by mouth after mid-night”. Results: Mild to moderate degrees of discomforts was seen in the study participants. Feelings of thirst and hunger were the serious discomforts experienced. The associated discomforts were not determined to be significantly different (p=0.256) among the two groups of comparison. Conclusion: The study concluded that the associated discomforts were not statistically different between the traditional and standard groups. There was mild to moderate degrees of discomforts in both groups of study. Though the finding shows similar magnitude of discomforts between the two comparison groups, postoperative discomforts appear to worsen as the timing of fasting increases.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nada Mohamed Bahaa Eldin Mostafa Abdel Rahman ◽  
Khaled Mohammed Maghawry ◽  
Raham Hasan Mostafa ◽  
Ahmed Wagih Ezzat
Keyword(s):  
Side Effects ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Intrathecal Injection ◽  
Group Versus ◽  
Rapid Onset ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Elective Cesarean ◽  
Fentanyl Group

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

scholarly journals Effect of Anesthesia Techniques on Pain Severity, Hemodynamic Changes, and Patients’ Satisfaction in Elective Cesarean Section

2020 ◽  
Author(s):  
Abdollah Jafarzadeh ◽  
Maryam Hadavi ◽  
Gholamhossein Hasanshahi ◽  
Mohsen Rezaeian ◽  
Reza Vazirinejad ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Cesarean Section ◽  
Diastolic Blood Pressure ◽  
Elective Cesarean Section ◽  
Hemodynamic Changes ◽  
Apgar Scores ◽  
Patients Satisfaction ◽  
Elective Cesarean

The severity of postoperative pain and hemodynamic changes during and post-cesarean section have a direct effect on the neonatal and maternal condition. This study aimed to compare pain severity, hemodynamic changes, and patient satisfaction following two anesthesia techniques in elective cesarean section. In this blinded study, 60 women who were candidate for cesarean section were allocated into two equal groups of general anesthesia (GA) and spinal anesthesia (SA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and O2 Saturation at pre cesarean (T0), the uterine incision time (T1), end of surgery (T2), 6h (T3), 12h (T4), and 24 hours post-cesarean (T5) were measured. A Visual Analog Scale assessed post-cesarean pain, 6, 12, and 24 hours post-cesarean. Gender, birth weight, first- and fifth- minutes’ apgar score was recorded in the checklists. The VAS score was significantly higher in the GA group at 6h, 12h, and 24 hours post-cesarean (P=0.014, P=0.002, P=0.017, respectively). SBP and DBP at T1 in the GA group were significantly higher than in the S.A group (P<0.001). The heart rate at T0 and T1 in the GA group was lower than the SA group (P=0.001, P=0.045 respectively). The difference between the apgar scores of the two groups was not significant. SA for cesarean section was associated with lower postoperative pain, systolic and diastolic blood pressure. However, the two groups had no significant difference in terms of patients’ satisfaction and apgar scores. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):424-429.

scholarly journals Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

2018 ◽  
Vol 1 (2) ◽  
pp. 70-74
Author(s):  
Rohini Sigdel ◽  
Maya Lama ◽  
Sanish Gurung ◽  
Bishal Gurung ◽  
Anil Prasad Neupane ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Operating Table ◽  
Hemodynamic Effects ◽  
Elective Cesarean ◽  
Spinal Hypotension ◽  
The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

scholarly journals Tranexamic acid in prevention of postpartum hemorrhage in elective cesarean section

2019 ◽  
Vol 8 (2) ◽  
pp. 372
Author(s):  
Pravin Shah ◽  
Ajay Agrawal ◽  
Shailaja Chhetri ◽  
Pappu Rijal ◽  
Nisha K. Bhatta
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Elective Cesarean Section ◽  
Controlled Study ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Elective Cesarean ◽  
The Mean

Background: Postpartum hemorrhage is a common and occasionally life-threatening complication of labor. Cesarean section is associated with more blood loss in compared to vaginal delivery. Despite, there is a trend for increasing cesarean section rates in both developed and developing countries thereby increasing the risk of morbidity and mortality, especially among anemic women. The objective of this study was to evaluate the effect of preoperative administration of intravenous Tranexamic acid on blood loss during and after elective cesarean section.Methods: This was a prospective, randomized controlled study with 160 eligible pregnant women of 37 or more period of gestation. They were all planned for elective cesarean section and were randomized into two groups either to receive 10ml (1gm) of Tranexamic acid intravenously or 10ml of normal saline. Blood loss was measured during and for 24 hours after operation.Results: The mean estimated blood loss was significantly lower in women treated with Tranexamic acid compared with women in the placebo group (392.13 ml±10.06 vs 498.69 ml±15.87, respectively; p<0.001). The mean difference in pre-operative and post-operative hemoglobin levels was statistically significant in the Tranexamic acid group than in the control group (0.31±0.18 vs 0.79±0.23, respectively; p<0.001).Conclusions: Pre-operative use of Tranexamic acid is associated with reduced blood loss during and after elective cesarean section. In a developing country like ours where postpartum hemorrhage is a major threat to the life of the mothers, it seems to be a promising option.

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