Key result
Addition of fentanyl or buprenorphine to 0.75% ropivacaine hastened the onset of sensory block (9.94 and 10.72 vs 14.59) and buprenorphine prolonged postoperative analgesia.
Why the study?
Does the addition of fentanyl or buprenorphine to ropivacaine improve analgesic efficacy in parturients undergoing elective cesarean section?
RCT (n=102)
Double-blind
computer-generated random number list
No
Does the addition of fentanyl or buprenorphine to ropivacaine improve analgesic efficacy in parturients undergoing elective cesarean section?
Absolute Event Rate: 9.94% vs 14.59%
The addition of buprenorphine to epidural ropivacaine significantly prolongs postoperative analgesia compared to fentanyl or ropivacaine alone in cesarean sections.
Supports buprenorphine addition to epidural ropivacaine for longer post-cesarean analgesia; extends RCT data on opioid adjuvants in obstetric anesthesia.
Context: The study was to compare the analgesic efficacy of three different epidural solutions - ropivacaine, ropivacaine fentanyl mixture, and ropivacaine buprenorphine mixture - for cesarean section. Materials and Methods: This was a prospective, randomized, controlled, double blind study carried out in primi parturients undergoing elective cesarean section with singleton fetus. A total of 102 parturients in the age group of 20-35 years, American Society of Anesthesiologists (ASA) I or II scheduled for elective cesarean under continuous epidural anesthesia were divided into three groups using a computer-generated random number list. The test dose (3 ml 2% lignocaine with 15 μg adrenaline) and 0.75% ropivacaine 12 ml were given to all parturients. In addition, normal saline 1 ml, fentanyl 50 μg, and buprenorphine 300 μg were given to Group I, II, and III respectively. Sensory block, motor block, analgesia, maternal effects, fetal outcome, and surgeons' and parturients' satisfaction were evaluated. Results: Onset of sensory block was faster in the fentanyl and buprenorphine groups compared to ropivacaine group (9.94 ± 0.48, 10.72 ± 0.26 versus 14.59 ± 0.34). Duration of sensory block was prolonged in buprenorphine group as compared to fentanyl and ropivacaine groups (120.41 ± 4.31) versus (95.68 ± 3.28, 98.28 ± 3.42). Duration of analgesia was prolonged in buprenorphine group compared to fentanyl and ropivacaine groups (516.38 ± 29.14 versus 327.06 ± 12.41, 285.78 ± 10.10). It proved to be safe for mother and fetus. The surgeon and the parturients were satisfied with the mode of anesthesia. Conclusion: Ropivacaine 0.75%, ropivacaine 0.75% with fentanyl 50 mg, or buprenorphine 300 mg provided safe anesthesia when given extradurally for cesarean section. Addition of both fentanyl and buprenorphine to ropivacaine hastened the onset of sensory block, while addition of buprenorphine provided prolonged excellent postoperative analgesia.
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Ipe et al. (2014) conducted an RCT in Cesarean section (n=102). Ropivacaine with fentanyl or buprenorphine vs. 0.75% ropivacaine 12 ml with normal saline 1 ml was evaluated on Onset of sensory block. Addition of fentanyl or buprenorphine to 0.75% ropivacaine hastened the onset of sensory block (9.94 and 10.72 vs 14.59) and buprenorphine prolonged postoperative analgesia.
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