Key result
Adding intrathecal fentanyl to bupivacaine reduces sensory analgesia onset time by ~25%.
Why the study?
Co-administering opioids and local anaesthetics intrathecally may provide synergistic anaesthesia with lower local anaesthetic doses, reducing hypotension while prolonging postoperative analgesia in parturients undergoing LSCS.
Does the addition of 12.5 mcg intrathecal fentanyl to bupivacaine improve the onset and duration of sensory analgesia in parturients undergoing elective LSCS?
RCT (n=90)
Computerized randomised sampling
No
Does the addition of 12.5 mcg intrathecal fentanyl to bupivacaine improve the onset and duration of sensory analgesia in parturients undergoing elective LSCS?
Absolute Event Rate: 1.67% vs 2.23%
p-value: p=<0.05
The addition of 12.5 mcg intrathecal fentanyl to bupivacaine for LSCS significantly shortens the onset and prolongs the duration of sensory analgesia without increasing side effects.
Supports faster sensory block onset for elective cesarean delivery; extends RCT evidence for intrathecal fentanyl as spinal adjunct.
Objective: After the discovery of opioid receptors in the spinal cord and direct opioid action at this level, possibility of synergism between opioids and local anaesthetics co-administered intrathecally has been explored in obstetric population undergoing LSCS.The synergistic action of local anaesthetic with opioid is of great benefit in achieving adequate anaesthesia with lesser dose of local anaesthetics thereby reducing the chances and severity of hypotension and to provide postoperative analgesia for longer duration.Design: The study was conducted in 90 parturients divided in two groups of 45 each scheduled to undergo elective Lower Segment Caesarian Section under spinal anaesthesia.After securing iv line, Group I patients received 0.5% (H) hyperbaric bupivacaine 10mg and Group II received 0.5%(H) Bupivacaine and 12.5mcg fentanyl intrathecally in L3-L4 space in left lateral position.After spinal, patients were made supine with wedge kept under right hip.All patients were assessed for time of onset of sensory analgesia ,maximum level of sensory blockade achieved, degree of motor blockade(Modified Bromage score),Duration of effective analgesia, any possible side effects Results: The time of onset of analgesia was shortened in Group II.In both groups mean height of analgesia was T4.The mean time to achieve highest sensory level was 3.96±1.65min in Group II as compared to 5.29±1.93min in Group I. Mean time for complete sensory recovery was 277.2±33.33 min in Group II as compared to 185±29.8min in Group I which was significant.Total duration of analgesia was prolonged in Group II, there were no significant side effects.Conclusions: From this study, we conclude that addition of 12.5 mcg of fentanyl decreases the time of onset of sensory analgesia, improves the quality of intraoperative anaesthesia, prolongs the duration of sensory analgesia without having significant effect on characteristics of motor blockade.It does not cause any significant haemodynamic changes and side effects in mother as well as neonate.It also reduced the demand for postoperative analgesia
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A 2020 study conducted an RCT in Elective Lower Segment Caesarean Section (n=90). Intrathecal Fentanyl and 0.5% Bupivacaine Heavy vs. 10 mg (2cc) 0.5% hyperbaric bupivacaine + 0.25 ml normal saline was evaluated on Time of onset of sensory analgesia at T10 segment (minutes) (p=<0.05). Addition of 12.5 mcg of intrathecal fentanyl to 0.5% bupivacaine significantly decreased the mean time of onset of sensory analgesia to 1.67 minutes compared to 2.23 minutes with bupivacaine alone.
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