Intrathecal nalbuphine versus fentanyl as an adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized double-blind study

2019 ◽  
Vol 6 (1) ◽  
pp. 112
Author(s):  
FarahatI Ahmed
Author(s):  
Priti Kumar ◽  
Sangeeta Arya ◽  
Sushil Kr. Singh ◽  
Sunil Kumar

Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover. 


Author(s):  
Mustafa Adnan Abdalrahman ◽  
Hassan Mohammed Abbas ◽  
Iyad Abbas Salman

Background: Hypotension is a very common consequence of the sympathetic vasomotor block caused by spinal anesthesia for caesarean section. Maternal symptoms such as nausea, vomiting and dyspnea frequently accompany severe hypotension, and adverse effects on the fetus, including depressed Apgar scores and umbilical acidosis, have been correlated with severity and duration of hypotension. Aim: To investigate the effect of Ondansetron use on the prevention of hypotension and the amount of vasopressor needed to control the hypotension after spinal anesthesia. Methods: This is a prospective double blind, randomized trial carried out in Obstetric Operation room of Baghdad Teaching Hospital, Medical city, Iraq from November, 2018 to August, 2019. Total number of 128 women assessed for eligibility and only 87 were included and allocated into 2 groups. The Ondansetron group (45 women) received 6 mg Ondansetron IV e min before induction of spinal anesthesia. The Placebo group received 3 ml normal saline as placebo before induction. The number of rescue drugs (vasopressors, antiemetic, anti-shivering), vital signs and side effects were recorded each 3 minutes from baseline to 45th minute. Results: The incidence of hypotension, nausea, vomiting and the need for vasopressors and metoclopramide were significantly lower in Ondansetron group than placebo group (p = 0.001, 0.02, 0.003, < 0.001, and 0.001, respectively). Shivering and the need of pethidine for treating this side effect was non significantly lower in ondansetron group than placebo group. Conclusions: The preoperative administration of Ondansetron in cesarean section reduces the risk of spinal anesthesia-induced hypotension, prevents the nausea and vomiting attacks and decreases the need to vasopressors and metoclopramide. Keywords: Spinal anesthesia, caesarian section, ondansetron, hypotension


2020 ◽  
Vol 15 ◽  
Author(s):  
Arash karimi ◽  
Jahanbakhsh Nejadi ◽  
Mahnaz Shamseh ◽  
Nooshin Ronasi ◽  
Mehdi Birjandi

Background: Postoperative nausea and vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study is to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. Methods: This double-blind clinical trial study was performed on patients who were referred to the operating room of Haji Karim Asali Hospital of Khorramabad for elective cesarean section in 2016-17. Upon meeting the inclusion criteria, patients were allotted into two groups (n=60). Group A received 8mg of dexamethasone and group B received 4mg of ondansetron after spinal anesthesia. The Visual Analog Scale (VAS) questionnaire and Depression-Anxiety-Stress Scale (DASS) questionnaire was used for the analysis. Patients with mild to moderate stress, anxiety, and depression were included in the study. Data were analyzed using SPSS 16 software. Results: There was no difference in the demographic data of the two groups. The mean severity of nausea in group A was significantly higher than in group B. The frequency of vomiting in group A was 20 times higher than group B, which was found to be statistically significant, p = 0.018. Concerning the type of delivery with the frequency of nausea, the results showed that the frequency of nausea in group A was 3.24 times higher than group B, however, this difference was not statistically significant, p = 0.106. Conclusion: Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in c-section surgical candidates.


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