Comparison of Intrathecal Meperidine, Fentanyl, or Placebo Added to 0.5% Hyperbaric Bupivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: The addition of various opioids to 0.5% hyperbaric bupivacaine intrathecally seems to potentiate analgesic effects of bupivacaine and to prolong the duration of analgesia. We compared the effect of intrathecal meperidine 0.25 mg/kg and 0.5 mg/kg, fentanyl 0.15 microgram/kg, and placebo when administered together with 0.5% hyperbaric bupivacaine 9 mg for cesarean section. METHODS: Forty-four healthy term parturients were randomly allocated (n = 11 per group) to receive the test solution (1 ml) containing preservative-free normal saline (control group), fentanyl 0.15 microgram/kg, meperidine 0.25 mg/kg, or meperidine 0.5 mg/kg intrathecally, immediately followed by the injection of 0.5% hyperbaric bupivacaine 9 mg. We observed the effective postoperative analgesic duration (time to VAS > or = 4), quality of anesthesia and side effects. RESULTS: The effective postoperative analgesic duration significantly increased in the groups receiving opioid compared with the control group (P < 0.05); control group 101.4 +/- 28.6 min; fentanyl group 192.3 +/- 29.2 min; meperidine 0.25 mg/kg group 208.8 +/- 21.7 min; meperidine 0.5 mg/kg group 289.8 53.6 min (data expressed as mean +/- SD). The quality of anesthesia was excellent in 100% of the meperidine group but in 82% of the fentanyl group and 91% of the control group. The incidence of nausea and vomiting were higher in the meperidine 0.5 mg/kg group (73%) than in the remaining groups (P < 0.05). CONCLUSIONS: The addition of fentanyl 0.15 microgram/kg or meperidine 0.25 mg/kg to 0.5% hyperbaric bupivacaine 9 mg for spinal anesthesia improves intraoperative analgesia and provides analgesia into the immediate postoperative period with no adverse effects on mother or neonate.

The Effects of Subarachnoid Fentanyl in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Combined spinal-epidural anesthesia (CSEA) for cesarean section has gained an increasing interest as it combines a reliability of spinal anesthesia and the flexibility of epidural anesthesia. The aim of this study is to compare the surgical analgesia and the frequency of side effects for cesarean section produced by CSEA using subarachnoid fentanyl or placbo. METHODS: The study was performed in a randomized, double-blined fashion in 40 (20 per group) healthy, full-term parturients presenting for elective cesarean section. We compared the effects of intrathecal fentanyl (20 microgram), and placebo when administered together with 0.5% hyperbaric bupivacaine 7 mg in combined spinal-epidural anesthesia (CSEA) for cesarean section. Patients' anesthetic levels, vital signs and intraoperative pain were recorded. If anesthetic level achieved by intrathecal injection was not sufficient for cesarean section (T4), additional 2% lidocaine 2 ml per segment was administered epidurally. Patients were asked to rate their severity of pain on a visual analog scale (VAS) score intraoperatively and intravenous fentanyl was administered if the patient experienced intraoperative discomfort. The quality and side effects of anesthsia and neonatal Apgar scores were compared between two groups. RESULTS: The number (percent) of patients achieved sensory block level above T4 by subarachnoid injection alone was significantly higher in the fentanyl group (17/18, 94.4%) than the control grop (10/16, 62.5%). The dose of epidural lidocaine was significantly less in the fentanyl group (p<0.05). The frequency of intraoperative pain was significantly less in the fentanyl group (17%) than in the control group (50%). CONCLUSION: We conclude that adding fentanyl into subarachnoid injection in CSEA for cesarean section significantly decreases the additional epidural local anesthetics and intraoperative pain.

Spinal Anesthesia Using 0.5% Hyperbaric Bupivacine/Fentanyl Mixture for Cesarean Section / 대한마취과학회지

BACKGROUND: The last two decades have seen an increase in the incidence of cesarean section. Spinal anesthesia has been popular in cesarean delivery because of the ease and effectiveness, as well as the rapidity in estabilishing adequate levels of analgesia. The clinical effects of subarachnoid administeration of preservative-free fentanyl were assessed in 30 healthy women who underwent cesarean section with spinal anesthesia using 0.5% hyperbaric bupivacaine. METHODS: Sixty parturients were allocated to group I; bupivacaine (n=30) only and group II; bupivacaine/fentanyl mixture (n=30) in random order. The dose of bupivacaine varied from 9~10 mg depending on the patients height. Maximum level of sensory blockade, time to reach T4 level, incidence of hypotension, time to get complete motor recovery, perioperative analgesic effect and complications were evaluated. RESULTS: There were no differences in maximum level of analgesia, time to reach T4 level and to get complete motor recovery, and incidence of hypotension between two groups. However, duration of analgesia was longer in group II with the bupivacaine/fentanyl mixture (191.9 +/- 77.6 min) than in group I with the bupivacaine alone (74.2 +/- 30.8 min). Spinal anesthesia was excellent in 100% of the fentanyl mixture group but in 80% of the bupivacine only group. CONCLUSION: 0.5% hyperbaric bupivacaine mixed with 25 g fentanyl provided improved perioperative analgesia without affecting the onset of sensory blockade and duration of motor blockade.