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

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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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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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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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

Journal of University of Shanghai for Science and Technology ◽

10.51201/jusst/21/09600 ◽

2021 ◽

Vol 23 (09) ◽

pp. 788-801

Author(s):

Dr. Ahmed Salam Dawood ◽

◽

Dr. Aimen Hameed Latef ◽

Keyword(s):

Blood Pressure ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Pulse Rate ◽

The Other ◽

Elective Cesarean Section ◽

Anesthesia Induction ◽

Sitting Position ◽

Hyperbaric Bupivacaine ◽

Lying Down

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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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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Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502014001800010 ◽

2014 ◽

Vol 29 (11) ◽

pp. 752-758 ◽

Cited By ~ 3

Author(s):

Angélica de Fátima de Assunção Braga ◽

Franklin Sarmento da Silva Braga ◽

Eunice Sizue Hirata ◽

Rosa Inês Costa Pereira ◽

José Aristeu Frias ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Randomized Controlled Study ◽

Elective Cesarean Section ◽

Controlled Study ◽

Hyperbaric Bupivacaine ◽

Randomized Controlled ◽

Elective Cesarean

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The effect of clonidine with bupivacaine on perioperative hemodynamics and post-operative analgesia in cesarean section cases

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212952 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3049

Author(s):

Priti Kumar ◽

Sangeeta Arya ◽

Sushil Kr. Singh ◽

Sunil Kumar

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Intraoperative Hypotension ◽

Elective Cesarean ◽

Group A ◽

Group B

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.

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