Resumo
Background: Intrathecal opioids have gained popularity in obstetrics; they augment the analgesia produced by local anaesthetic agents. The aim of this study is to determine the duration of analgesia following addition of fentanyl to bupivacaine during elective Caesarean section.
Method: This is a prospective randomized study comparing the effect of addition of 25 µg of fentanyl to 2.5 mls of 0.5% hyperbaric bupivacaine intrathecally on sixty healthy women of American Society of Anaesthesiologist(ASA) physical status I scheduled for elective Caesarean section at the UCH, Ibadan. Patients were randomized to group B, n=30 and group FB, n=30. Maternal heart rate, blood pressure, respiratory rate, sensory level, motor block, pain score (NRS) and side effects were observed every 2 minutes for first 15 minutes, then at 5 minutes interval for the remainder of the operation. Thereafter at 30 minutes interval until the first complaint of pain.
Results: Complete analgesia (time from injection of intrathecal drug to first report of pain) lasted longer in group FB (240 ±29 minutes) than group B (99±12 minutes) with a p- value of 0.002. The duration of effective analgesia (time from injection of intrathecal drug to first request for analgesic) in group FB (276±26 minutes) while group B was (121±10 minutes) with a p-value of 0.001. Both were statistically significant.
Conclusion: We conclude that the addition of 25 µg of fentanyl to bupivacaine intrathecally for elective Caesarean section increases the duration of complete and effective analgesia thereby reducing the need for early postoperative use of analgesics.
Keywords: Elective Caesarean section, intrathecal fentanyl, duration of analgesia.
Résumé
Les opioïdes intrathecaux ont gagnés une popularité chez les obstétriciens; Ils augmentent l’analgésie produit par les agents anesthétiques locaux. Le but de cette étude est de déterminer la durée de l’analgésie après l’addition de la fentanyl à la bupivacaine pendant la scission élective césarienne. Cette étude prospective non sélective comparant l’effet de l’addition de 25 µg de fentanyl à 2.5 mls de 0.5% bupivacaine hyperbolique intrathecale chez soixante femmes de statut physique ASA programmées pour une scission césarienne élective à UCH, Ibadan. Les patients étaient sélectionnés en groupe B, n=30 et le groupe FB, n=30. La fréquence du battement cardiaque, pression artérielle, fréquence respiratoire, niveau sensorielle, block moteur, résultat de la
douleur (NRS) et les effets indésirables étaient observés chaque 2minutes pour les premières 15 minutes, ensuite après un interval de 5 minutes durant le reste de l’opération et l’intervalle de 30 minutes à la première plainte de douleur. L’analgésie complète (temps d’injection du médicament intrathecale à la première plainte de la douleur) durait plus longtemps au groupe FB (240 ±29 minutes) que le groupe B (99±12 minutes) avec une valeur de p de 0.002. La durée effective d’analgésie (temps d’injection du médicament intra-thecale à la première demande d’un analgésique) chez le groupe FB (276±26 minutes) tandis que le groupe B était (121±10 minutes) avec une value de P de 0.001, étant tous statistiquement significative. Nous avons conclu que l’addition de 25 µg de fentanyl à la bupivacaine intra-thecale pour une scission élective de Césarienne augmentait la durée effective et complète d’analgésie, ainsi réduisant l’usage d’analgésique post opérative précise.
Correspondence: Dr. O.A. Idowu, Reddington Specialist Hospital, 12, Idowu Martins Street, Victorial Island, Lagos, Nigeria. E-mail: solaidowu@gmail.com or idsolid4u@yahoo.com
Referências
Hinnerk FW. The centennial of spinal anaesthesia. Anesthesiology 1998; 89: 500-506.
Abouleish E, Rawal N, Shaw J, Lorenz T, and Rashad MN. Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination; effects on parturients. Anesthesiology 1991; 74; 711-716.
Hunt CO, Naulty JS and Bader AM. Perioperative analgesia with subarachnoid fentanyl with bupivacaine for Caesarean delivery. Anesthesiology 1989; 71; 535-540.
Etches RC, Sandler AN and Daley MD. Respiratory depression and spinal opioids. Can J. Anaesth 1989; 36; 165-185.
Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW and Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for caesarean section. Anesth Analg 1997; 85:1288-1293.
Yu SC, Kee Ngan WD and Kwan ASK. Addition of meperidine to bupivacaine for spinal anaesthesia for caesarean section. Br J. Anaesth, 2002; 88:379-383
Morgan M. The rational use of intrathecal and extradural opioids. Br J. Anaesth 1989; 63: 165 188.
Siegel T and Mayzner-Zawadzka E: Regionalna anestezja w Polsce w 2002 roku. Anaesthesiol Intensive Ther 2004; 36: 89-96.
Duck HC, Hyun J A and Myung HK: Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med 2000; 25: 240-245.
Kiran S and Singal NK: A comparative study of three different doses of 0.5% Hyperbaric bupivacaine for spinal anaesthesia in elective caesarean section. Int J Obstet Anaesth 2002, 11: 185-189.
Hamber EA and Viscomi CM: Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999; 24: 255-263
Chan JC, Sung HY, Gi BH, Jung SP and Young JC: Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery. Reg Anesth Pain Med 2002; 27: 600-603.
Wang C, Chakrabarti MK and Whitwam JG. Specific enhancement by fentanyl on the effects of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathway in dogs. Anesthesiology 1993; 79; 766-773.
Biswas BN, Rudra A, Bose BK, Nath S, Chakrabaty S and Bhattacharjee S. Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in the early post operative period. Indian J. Anaesth. 2002; 46: 469-472.
Belzarena, Seargio D. The effects of intrathecally administered fentanyl in patients undergoing Caesarean section . Anaesth Analg, 1992; 74: 653-657
Wojciech W, Andrzej B, Sietlana K-W and Ewa M-Z: Comparative study of postoperative analgesia after intrathecal administration of bupivacaine with fentanyl or morphine for elective Caesarean section. Anaesthesiol Intensive Ther, 2009,1; 25-29
Girgin NK, Gurbet A, Turker G, Aksu H and Gulhan N. Intrathecal morphine in anesthesia for caesarean delivery: dose-response relationship for combinations of low-dose intrathecal morphine and spinal bupivacaine.J Clin Anesth.2008; 20:180-185.
Desalu I and Kushimo OT. Is ephedrine infusion more effective at Preventing hypotension than traditional prehydration during spinal anaesthesia for Caesarean section? Int J Obstet Anesth 2005:14:294-299.
Amanor- Boadu S.D. Assessment of minidose intrathecal morphine for analgesia after haemorrhoidectomy. West Afr. J. Med. 1992; 11: 146- 149.
Soyannwo O.A. Post operative pain control prescription pattern and patients’ experience. West Afr J. of Med. 1999: 18: 207-210.
Kolawole I.K. and Fawole A.A. Postoperative pain management following caesarean section in University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. West Afr. J. Med. 2003; 22: 305- 309.
Dahl BD, Jeppesen IS, Jorgensen H, Wetterslev J and Moiniche S: Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing caesarean section with spinal anaesthesia. Anesthesiology 1999; 91: 1919-1927.