Addition of Fentanyl to Hyperbaric Bupivacaine in spinal anesthesia for Caesarian section – effect on dose of local anesthetic and duration of postoperative analgesia – a randomized comparative study

JMS SKIMS ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 62-68
Author(s):  
Ghulam Mohammed Mir ◽  
Mohammed Abdul Haadi
Keyword(s):  
Spinal Anesthesia ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Low Dose ◽  
Caesarian Section ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Group I ◽  
Low Incidence ◽  
Fentanyl Group

Background: Spinal anesthesia is commonly used for caesarian section for its reliability and ease of administration. However, it is limited by fixed duration of anesthesia, hypotension and lesser control of block height. The combination of reduced dose of local anesthetic agent with intrathecal opioid makes it possible to achieve adequate spinal anesthesia with minimum hypotension and prolonged postoperative analgesia. The study aims to monitor the effect of intrathecal fentanyl and bupivacaine on reduction of higher blocks and simultaneously improving the quality and avoiding higher doses of local anesthesia agents. Methods: Forty patients scheduled for elective caesarian section were divided in to two groups of twenty each. Group I patients received Bupivacaine 12.5 mg (0.5%) for spinal anesthesia and group II patients received combination of Bupivacaine 8.5 mg (0.5%) with fentanyl 25 mcg. Patients were observed for hypotension, bradycardia, nausea, pruritus, quality of surgical anesthesia and duration of postoperative analgesia. Results: All the patients had adequate surgical anesthesia for the procedure and in no patient conversion to general anesthesia was required. Peak sensory level was higher (T2-T3 vs T4-T6) and motor block was more intense in the regular dose bupivacaine group of patients. More patients in bupivacaine only group developed hypotension and the requirement of vasopressors was significantly higher than the low dose bupivacaine with fentanyl group. Also the Visual analogue scale score for pain was less in the bupivacaine-fentanyl group, who received less postoperative analgesics for first twelve hours. Conclusions:  We conclude that combination of low dose bupivacaine (8.5mg) with fentanyl provides adequate surgical anesthesia for caesarian section and with low incidence of hypotension and nausea. Also, addition of fentanyl helps in prolongation of postoperative analgesia. JMS 2017;20(2):62-68

Prediction of Post spinal anesthesia hypotension in patients undergoing cesarean section using Perfusion index

2020 ◽  
Vol 5 (3) ◽  
pp. 1241-1245
Author(s):  
Kumud Pyakurel ◽  
Lalit Kumar Rajbanshi ◽  
Ramesh Bhattarai ◽  
Sonia Dahal
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Supine Position ◽  
Roc Curve ◽  
Anesthetic Management ◽  
College Teaching ◽  
Perfusion Index ◽  
Sensory Level ◽  
Roc Curve Analysis ◽  
Group I

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001).  Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

scholarly journals Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial

2016 ◽  
Vol 66 (6) ◽  
pp. 622-627 ◽  
Author(s):  
Alexandre Dubeux Dourado ◽  
Ruy Leite de Melo Lins Filho ◽  
Raphaella Amanda Maria Leite Fernandes ◽  
Marcelo Cavalcanti de Sá Gondim ◽  
Emmanuel Victor Magalhães Nogueira
Keyword(s):  
Clinical Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Randomized Clinical Trial ◽  
Low Dose ◽  
Hyperbaric Bupivacaine

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 Ultrasound Guided Femoral Nerve Block with Bupivacaine versus Bupivacaine and Tramadol for Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty under Spinal Anesthesia

2021 ◽  
pp. 23-32
Author(s):  
Mohammad Mostafa Abo Farrag ◽  
Laila Elahwal ◽  
Hesham Mohammad Maroof ElDomairy ◽  
Mohammad Ibrahem Okab
Keyword(s):  
Total Knee Arthroplasty ◽  
Spinal Anesthesia ◽  
Nerve Block ◽  
Knee Arthroplasty ◽  
Postoperative Analgesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Ultrasound Guided ◽  
Group I ◽  
Total Knee

Background: Effective pain control in Total knee arthroplasty (TKA) is important for optimizing the rehabilitation process in order to achieve patient satisfaction with a good functional outcome as well as reduce hospitalization duration and costs. Combined use of aesthetic with tramadol has been reported to achieve a longer duration of sensory and motor block. The aim of this study is to evaluate the quality and duration of postoperative analgesia produced by ultrasound guided femoral nerve block (FNB) by bupivacaine versus (bupivacaine & tramadol) in patients undergoing total knee arthroplasty under spinal anesthesia. Methods: This prospective randomized controlled double blinded study was carried out on 60 patients aged above 50 years; American Society of Anesthesiologists physical status (ASA) I-III scheduled for total knee arthroplasty under spinal anesthesia. Patients were randomized to one of two equal groups: Group I control (C): received FNB with 30 ml 0.25% bupivacaine. Group II tramadol (T): received FNB with 30ml 0.25% bupivacaine and 100 mg tramadol. Results: Postoperative heart rate was significantly increased in group C than group T at 8h, 12h, 16h and 24h. Postoperative mean arterial blood pressure was significantly increased in group C than group T at 6h, 8h, 12h, 16h and 24h. There were 30 (100%) patients required rescue analgesia in group C and 19 (63.33%) patients in group T which was increased significantly in group C than group T. The time to first analgesic requirement was significantly decreased in group C than group T. Total morphine consumption was increased significantly in group C than group T. VAS was increased significantly in group C than group T at 6, 8, 12, 16 and 24 hours. Adverse effects were insignificantly different between both groups. Conclusion: Adding tramadol (100 mg) to 0.25% bupivacaine (to a volume of 30 ml) during US guided FNB of TKA under spinal anesthesia was associated with better postoperative analgesia when compared with 0.25% bupivacaine alone.

scholarly journals A comparative study of low doses of intrathecal ketamine and midazolam with bupivacaine for postoperative analgesia in infraumbilical surgeries

2019 ◽  
Vol 6 (2) ◽  
pp. 197
Author(s):  
Rajabhushanam M. ◽  
Sunil Kumar K. ◽  
Syed Ali Aasim ◽  
Venkatesh S.
Keyword(s):  
Postoperative Analgesia ◽  
Cost Effective ◽  
Rapid Onset ◽  
Spinal Block ◽  
P Value ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
First Choice ◽  
Mean Time

Background: Infra-umbilical surgeries may be performed under local, regional (spinal or epidural) or general anaesthesia, spinal block is still a first choice, because of its rapid onset, high quality of blockade, lack of catheter related infection, less failure rate and also cost effective but the duration of block and postoperative analgesia is limited. The purpose of study was to compare the efficacy of adding ketamine to 0.5% hyperbaric bupivacaine with midazolam to 0.5% hyperbaric bupivacaine in elective infraumbilical procedures.Methods: A randomized, single blinded, clinical study. 60 subjects were enrolled from the patients presenting for elective infraumbilical surgeries after following the inclusion and exclusion criteria laid down for the study. Sixty ASA Grade I and II patients undergoing infra umbilical surgeries were randomly divided into one of the two equal groups (n=30).Results: Total 60 patients were included in this study. The mean time to achieve T10 sensory level and modified bromage scale III was prolonged in group M (4.33±1.09, 6.66±1.26 min) as compared to group K (3.3±0.7, 4.96±1.21 min) which was statistically significant (P value <0.05).Conclusions: The present study concludes that addition of intrathecal midazolam to hyperbaric bupivacaine provide very good and prolonged post-operative analgesia without significant intra-operative and post-operative side effects compared to intrathecal ketamine.

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

scholarly journals Low Dose Bupivacaine plus Fentanyl in Subarachnoid Block for Caesarean Section

2016 ◽  
Vol 4 (1) ◽  
pp. 24-30
Author(s):  
Nasir Uddin Ahmed ◽  
Masuda Islam Khan ◽  
Aynul Islam Khan ◽  
AKM Akhtaruzzaman
Keyword(s):  
Blood Pressure ◽  
Caesarean Section ◽  
Systolic Blood Pressure ◽  
Postoperative Analgesia ◽  
Low Dose ◽  
Hyperbaric Bupivacaine ◽  
Haemodynamic Stability ◽  
Group A ◽  
Group B ◽  
Mean Time

Background: Spinal anaesthesia induced hypotension, a common problem during caesarean section, is associated with maternal nausea and vomiting and the risk of neonatal acidosis. Low dose local anaesthetic combined with opioids spinal anaesthesia better preserves maternal haemodynamic stability, resulting in equally efficacious anaesthesia.Objectives: To investigate whether this synergistic action could be used to provide effective anaesthesia while preventing hypotension during caesarean operation.Materials and method: This prospective study included 60 pregnant mothers scheduled for caesarean operation who were then divided into two groups (thirty in each). Group-A received a spinal injection of 12.5 mg of standardized 0.5% hyperbaric bupivacaine and group-B received 8 mg of 0.5% hyperbaric bupivacaine with 20 ?gm fentanyl. Hypotension was defined as the systolic blood pressure drops below 90 mm of Hg or a decrease of systolic blood pressure 25% from pre anaesthesia level and hypotension was treated with a bolus of 5 to 10 mg of intravenous ephedrine. The quality of anaesthesia and postoperative analgesia were evaluated.Results: The mean time required to reach peak sensory level was earlier in group-B than group-A and was statistically significant (p<0.05). The decrease in systolic blood pressure in group-A was significantly more than group-B (p<0.05) and vasopressor requirement was also significantly more in group-A compared to group-B (p<0.05). Mean time of two segment regression of sensory analgesia and complete sensory recovery was significantly early in group-B (p<0.05). Duration of motor recovery in group-B was significantly earlier (p<0.05). The duration of effective analgesia was significantly more in group-B (p<0.05).Conclusion: Low dose Bupivacaine with fentanyl provided excellent intraoperative sensory and motor blockade, haemodynamic stability, and effective postoperative analgesia for caesarean delivery.Delta Med Col J. Jan 2016 4(1): 24-30

Low-Dose Spinal Anesthesia with Hyperbaric Bupivacaine with Intrathecal Fentanyl for Operative Hysteroscopy: A Case Series Study

2012 ◽  
Vol 19 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Pasquale Florio ◽  
Rosa Puzzutiello ◽  
Marco Filippeschi ◽  
Pasquale D’Onofrio ◽  
Liliana Mereu ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Low Dose ◽  
Case Series ◽  
Hyperbaric Bupivacaine ◽  
Operative Hysteroscopy ◽  
Case Series Study ◽  
Series Study

scholarly journals PERIOPERATIVE EFFECTS OF INTRATHECAL CLONIDINE AND FENTANYL WITH HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR VAGINAL HYSTERECTOMY

2016 ◽  
Vol 9 (5) ◽  
pp. 245
Author(s):  
Suman Chattopadhyay ◽  
Mallika Datta ◽  
Biswanath Biswas
Keyword(s):  
Placebo Group ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Mechanisms Of Action ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Prolonged Duration ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

ABSTRACTObjectives: Intrathecal fentanyl and clonidine are effective analgesics with different mechanisms of action. This study compares 25 µg of both thesedrugs given intrathecally regarding onset, quality, and duration of hyperbaric bupivacaine-induced spinal block and side effects.Methods: A total of 90 patients of ASA I and II were randomly allocated into three equal groups. Group A received 0.5 ml of 0.9% normal saline(placebo), Group B and Group C received 25 µg fentanyl and clonidine intrathecally added to 2.5 ml of 0.5% hyperbaric bupivacaine, respectively. Theonset and regression time of sensory and motor blocks were recorded along with hemodynamic change, side effects, pain intensity (in terms of visualanalog score (VAS), and time to first rescue analgesic.Results: Intrathecal clonidine (25 μg) significantly prolongs sensory and motor blocks, with prolonged duration of analgesia in comparison withintrathecal fentanyl (25 µg) (325±15 minutes vs. 240±7.6 minutes). VAS score was similar, but sedation was more in clonidine group.Conclusion: We conclude that low-dose intrathecal clonidine is an effective adjuvant to bupivacaine for spinal anesthesia and provides betterpostoperative analgesia in comparison with intrathecal fentanyl.Keywords: Clonidine, Fentanyl, Bupivacaine, Regional, Spinal, Postoperative pain.

scholarly journals Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease

2019 ◽  
Author(s):  
Isngadi Isngadi ◽  
Rudi Hartono ◽  
Dewi Puspitorini Husodo ◽  
Eka Sunarwidhi Prasedya
Keyword(s):  
Heart Disease ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Low Dose ◽  
Fetal Outcome ◽  
Post Injection ◽  
Physiological Changes ◽  
Hyperbaric Bupivacaine ◽  
Metabolic System

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 μg fentanyl for caesarean section in patient with heart disease.Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 μg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician.Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation.Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 μg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.Citation: Husodo DP, Isngadi I, Hartono R, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesth pain & intensive care 2019;23(3):274-278

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