Comparison of hemodynamic and analgesic effect of pre mixed versus sequential administration of intrathecal fentanyl with hyperbaric bupivacaine on patients who undergo elective cesarean section.

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Addis Abeba University


Background: Spinal anesthesia (SA) is the most commonly used thechiniqe of anesthesia for elective cesarean section. The main drawback of Spinal anesthesia is hemodynamic instability and short duration of analgesia. To minimize this draw back adding opoids like fentanyl either pre mixed with local anesthetics or sequentially with separate syringe become common practice. But pre mixing alters their density and then their analgesic and hemodynamic effect. Objective: To compare the hemodynamic and analgesic effect of sequential versus pre mixed injection of intrathecal fentanyl with hyperbaric bupivacaine for patients who underwent elective CS under SA at Empress Zewiditu memorial hospital from January 01 to March 30, 2020 G.C. Method: Institutional based prospective cohort study was employed on 66 parturients who undergone elective cesarean section under SA fulfilling the inclusion criteria. Those who had received pre mixed technique were grouped as (M-group) and those who received sequentially were grouped as (S- group). Data was collected perioperatively at different time interval. Based on normality assumption, analysis was done by independent t test for normally distributed data, Mann –Whitney U test for non-normally distributed data and x 2 test for categorical variable. Pvalue <0.05 was consider as statistically significant. Result: There was significant decreament in Perioperative mean atrial blood pressure in M- group compared to S- group at 5 th , 10 th and 15 th minute, (p=<0.001). There was no significance difference in Perioperative mean hear rate change between groups, (p> 0.05). The mean time for the first rescue analgesic request time was prolonged in S- group compared to M- group (287.909±15.255 vs 261.39 ± 25.378) min respectively, (p < 0.001). The median Postoperative pain VAS score was significantly lower in S- group compared to M- group at 4 hr, (p<0.05). The incidence of hypotension was higher in M- group compared to S- group, (p< 0.05). Conclusion and recommendation: Sequential intrathecal injection of fentanyl and hyperbaric bupivacaine provided significant improvement in the quality of sensory block and hemodynamic stability compared to injection of premixed medications. We recommended sequential technique of spinal anesthesia for elective cesarean section compared to pre mixed. th ,5 th and 6 th



Hyperbaric bupivacaine, fentanyl, spinal anesthesia, pre mixed, sequential, cesarean section.