Hemodynamic and analgesic effect of intrathecal fentanyl as adjuvant with low and conventional dose of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia
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Date
2019-06
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Addis Ababa University
Abstract
Background: Spinal anesthesia with local anesthetic agents, especially bupivacaine, has side effects such as hypotension, respiratory depression, vomiting and shivering .Its side effects are dose dependent, therefore different approaches have been attempted in order to avoid spinal-induced complications including the use of small dose of bupivacaine or by lowering the dose of local anesthetic and mixing it with additives like Neuraxial opioids.
Objective: The objective of this study is to compare Hemodynamic and analgesic effect of intrathecal fentanyl as adjuvant with low and conventional dose of bupivacaine in patients undergoing elective cesarean section under spinal anesthesia
Methodology: An institutional based prospective cohort study was conducted on 90 patients who fulfill inclusion criteria for cesarean section under spinal anesthesia from December 1-March 30, 2019.Study participants was selected by systematic random sampling technique. Data collection methods include preoperative chart review, intraoperative observation and postoperatively patient interview after informed consent and aim of study is explained to the patient. Two trained anesthetists with continuing supervision from principal investigator collected data. The data was entered into EPI INFO and transport to SPSS version 23 for analysis of variable using one way ANOVA, kruskal wallis H rank test and chi-square.
Result: The comparison of data showed that there is significant difference in arterial blood pressure between LBF vs CBF group and LBF VS CB group with adjusted p value of < 0.05.duration of analgesia was prolonged in LBF and CBF group which is 248± 35.6 and 260.3±40.3 minute respectively compared with CB group (167.10 ± 31.45) with p-value <0.05.time for analgesic request also prolonged in fentanyl added groups which is 304±47.8 minute, 294.6±99.5 and 177±25.88 for LBF,CBF and CB group respectively.
Conclusion and recommendation: use of intrathecal fentanyl as adjuvant with low dose bupivacaine for cesarean section is effective in maintaining hemodynamic stability with improved intraoperative and early postoperative analgesia without any effect on the mother and fetus. We recommend the use of 25mcg intrathecal fentanyl with 8mg bupivacaine as appropriate to improve the hemodynamic status of patients in addition to improve intraoperative and early postoperative analgesia for elective cesarean section in hospital.
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Hemodynamic , analgesic effect,spinal anesthesia