RESUMEN
Background: In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal opioids have been found to fulfil both these objectives. This study was done to evaluate the effects of adding sufentanil to bupivacaine for spinal anesthesia. Methods: 100 ASA grade I/II patients aged between 20 – 60 years undergoing elective lower abdominal, urologic, lower limb surgeries were selected and divided into two groups of 50 each. Group A received 2.5 ml of heavy Bupivacaine, whereas the second group B received 2.5 ml of heavy Bupivacaine with 5 μg Sufentanil. Parameters - Onset and duration of sensory block and motor block, time for two dermatomal segments regression, duration of analgesia, vitals and side effects were assessed. Results: There was no variation in onset of sensory blockade and motor blockade. The time to achieve peak sensory level was 3 minutes earlier in group B. The time for two segment regression and the time to full sensory and motor recovery were prolonged in Group B. Duration of complete and effective analgesia prolonged by 40-60 minutes and the time for first request of analgesic postoperatively was delayed by 70 - 80 minutes in group B. The quality of analgesia was better in group B. Pruritus was the common side effect in group B. Conclusions: Sufentanil potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia with minimal side effects.
RESUMEN
Background: Pain in labour is an extremely agonising experience for most women. Unrelieved labour pain produces many physiological changes which are detrimental to both the mother and the foetus. Various methods have been used to alleviate this pain. It is now well recognized that the only consistently effective method of pain in labour is lumbar epidural analgesia. Using a higher concentration of local anaesthetic agent to produce analgesia can be associated with undesirable side effects such as motor block, haemodynamic disturbances or interference with the progress of labour. Hence, various adjutants like adrenaline, clonidine and particularly opioids have been used to reduce the amount of local anaesthetics used and yet provide satisfactory analgesia. In view of the above, the present study assesses the clinical effectiveness of continuous lumbar epidural analgesia for vaginal delivery by using 0.0625% bupivacaine with 2μg/ml of fentanyl. Methods: Forty parturient admitted to Chennai Medical College and Hospital, Trichy, for vaginal delivery and who were in active labor was given 8 ml of 0.0625% bupivacaine with 2μg/ml of fentanyl. The parturient were assessed with respect to onset and duration of analgesia, maximum level of analgesia, pain scores, homodynamic parameters, motor block, side effects, mode of delivery and neonatal outcome. Results: The onset of analgesia was significantly faster in 0.0625% bupivacaine with 0.0002% fentanyl (9.7 minutes). A greater proportion of parturient achieved a maximum level of analgesia unto T8. The duration of analgesia was also significantly longer. The effectiveness of analgesia was better. There were no significant cardiovascular changes or any motor blockade. The side effects were mild sedation and in the parturient who received fentanyl. The mode of delivery and the Apgar scores of the neonates at 1 and 5 minutes were comparable. Conclusions: It was concluded that continuous lumbar epidural analgesia with 8 ml of 0.0625% bupivacaine with 2 μg of fentanyl improved the quality and duration of analgesia without producing any adverse effects on the mother or on the neonate.