Comparison of 1-and 2- Minute Sitting Position Versus Immediately Lying Down of Hemodynamic Variables after Spinal Anesthesia with Hyperbaric Bupivacaine in Elective Cesarean Section

the aim of current study: was Comparison of 1-and 2- minute sitting position versus immediately lying down on hemodynamic variables after spinal anesthesia with hyperbaric bupivacaine in elective cesarean section. Patients and methods: This study was performed after the approval of the Iraqi Council for Medical Specialization in anesthesia and intensive care, and after obtaining the consents from 90 pregnant women (at term) who were candidate for cesarean section with spinal anesthesia were recruited in this study. They were collected from “AL-Imamain AL-Kademain Medical City Teaching Hospital” (July 2017 – January 2018) , All patients were premedicated with 10mg IV metoclopramide and 50mg IV ranitidine , Base line blood pressure and the pulse rate were recorded initially before intervention , the Lumbar puncture was performed in the sitting position under full aseptic teqnique , For assessment of blood pressure and pulse rate, ten readings were taken at (3, 5, 10, 15, 20, 25, 30, 35,40and 60 min) using an automated noninvasive blood pressure. Pulse rate monitored by electrocardiogram and oximetry (SPO2). Results: Current study showed higher means of pulse rate than the other two groups especially at early times after anesthesia induction. On the other hand, both group A1 and A2 showed higher mean of systolic, diastolic and mean blood pressure than group B especially 3, 5, 10 and 15 minutes after anesthesia induction, so the variation of pulse rate over the time in the three groups. Group B had higher pulse rate Journal of University of Shanghai for Science and Technology ISSN: 1007-6735 Volume 23, Issue 9, September – 2021 Page-7882 than the other two groups at 3,5,10, 25 and 40 minutes with significant difference (P8 in all groups. Conclusions: This study revealed that the patient’s position is an important factor, which affects the frequency of Hypotension and the onset of sensory block , as well as Administration of spinal anesthesia for cesarean section. Based on the findings, keeping the parturient seated for 1 Or 2 minutes after spinal anesthesia, compared to immediately lying down, could decrease the frequency of hypotension.

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Comparison of 1- and 2-Minute Sitting Positions Versus Immediately Lying Down on Hemodynamic Variables After Spinal Anesthesia with Hyperbaric Bupivacaine in Elective Cesarean Section

Anesthesiology and Pain Medicine ◽

10.5812/aapm.43462 ◽

2017 ◽

Vol 7 (2) ◽

Author(s):

Pooran Hajian ◽

Mahshid Nikooseresht ◽

Tayebe Lotfi

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Hemodynamic Variables ◽

Elective Cesarean ◽

Lying Down

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

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i2.24560 ◽

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.

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

QJM ◽

10.1093/qjmed/hcab086.088 ◽

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.

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Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

Galen Medical Journal ◽

10.31661/gmj.v5i1.475 ◽

2016 ◽

Vol 5 (1) ◽

pp. 13-18

Author(s):

Pouran Hajian ◽

Bita Malekianzadeh ◽

Maryam Davoudi

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Placebo Group ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Nausea And Vomiting ◽

Elective Cesarean Section ◽

Controlled Clinical Trial ◽

Sterile Water ◽

Elective Cesarean

Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron given intravenously with antiemetic dose (4 mg) decreases mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

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Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 859-863

Author(s):

Sangeeta Subba ◽

Arjun Arjun Chhetri ◽

Rupak Bhattarai

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Safe Alternative ◽

Elective Cesarean ◽

Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

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

Anesthesiology ◽

10.1097/00000542-200109000-00020 ◽

2001 ◽

Vol 95 (3) ◽

pp. 668-674 ◽

Cited By ~ 99

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.

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Safety and effectiveness of coadministration of intrathecal sufentanil and morphine in hyperbaric bupivacaine-based spinal anesthesia for cesarean section

Journal of Opioid Management ◽

10.5055/jom.2009.0021 ◽

2018 ◽

Vol 5 (4) ◽

pp. 197 ◽

Cited By ~ 6

Author(s):

Gaetano Draisci, MD ◽

Luciano Frassanito, MD ◽

Raffaella Pinto, MD ◽

Bruno Zanfini, MD ◽

Gabriella Ferrandina, MD ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Intrathecal Morphine ◽

Controlled Trial ◽

Group Versus ◽

Elective Cesarean Section ◽

Single Administration ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Significant Group

Subarachnoid block is a widely used technique for cesarean section. Opioids adding to the local anesthetics can improve its quality. In this prospective, randomized, double blind, controlled trial, we compared the effects of coadministration of intrathecal sufentanil and morphine with intrathecal sufentanil and a single administration of subcutaneous morphine. Sixty-four pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned to two groups according to the way of administration of morphine: intrathecal sufentanil (5 μg) plus intrathecal morphine (150 μg) (ITM group), and intrathecal sufentanil (5 μg) plus single administration of 10 mg subcutaneous morphine (SCM group). In both groups, the local anesthetic used was hyperbaric bupivacaine 0.5 percent (10 mg). Both groups received 1 g acetaminophen every 6 hours. In the postoperative period, pain was recorded on a 0-100 visual analog scale (VAS) and intravenous tramadol (100 mg) was administered if VAS score was >40 mm. Collateral effects, such us nausea, itching, respiratory depression, and sedation were assessed. VAS scores at rest and on coughing were significantly higher in the SCM group than in the ITM group between 3 and 24 hours. The mean titrated dose of tramadol consumed was also significantly greater in the SCM group than in the ITM group (p < 0.05). The time to first administration of tramadol was lower in the SCM group versus the ITM group (p < 0.05). The incidence of nausea was significantly lower in the SCM group than in the ITM group (p < 0.05). There was no significant group difference in the incidence of pruritus (p > 0.05). In conclusion, coadministration of sufentanil and morphine into the subarachnoid space was effective and provided longer pain relief than intrathecal sufentanil plus a single injection of subcutaneous morphine, despite a higher incidence of side effects such as nausea and vomiting.

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Intrathecal Sufentanil for Labor Analgesia Does Not Cause a Sympathectomy

Anesthesiology ◽

10.1097/00000542-199710000-00022 ◽

1997 ◽

Vol 87 (4) ◽

pp. 874-878 ◽

Cited By ~ 19

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.

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Evaluation of adjunctive analgesia with intrathecal fentanyl along with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203439 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2924

Author(s):

Ranu Neelamchand Surana ◽

Trishala Jain

Keyword(s):

Side Effects ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Analgesic Efficacy ◽

Sensory Block ◽

Elective Cesarean Section ◽

P Value ◽

Hyperbaric Bupivacaine ◽

Analgesic Requirement ◽

Elective Cesarean

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.

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