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A double blind randomized control trial to compare the effect of varying doses of intrathecal fentanyl on clinical efficacy and side effects in parturient undergoing cesarean section.
Abstract Number: F2D-8
Abstract Type: Original Research
Background and Aims: It is a common practice to add intrathecal lipophilic opioids to local anesthetics to improve the quality of subarachnoid block. It is however associated with side effects like pruritus, nausea/vomiting and respiratory depression.1 The evidence regarding appropriate dose of intrathecal fentanyl is still under investigation.2 Previous research assessing varying doses of intrathecal fentanyl for clinical efficacy did not have sufficient power to detect the differences in secondary outcome variables such as pruritus, respiratory depression, nausea and vomiting. 2This study was designed to find a dose of intrathecal fentanyl, which can improve the quality of surgical anesthesia with minimal side effects in parturient undergoing cesarean section under spinal anesthesia with intrathecal bupivacaine.
Methods: In a prospective randomized double blind study, 243 parturient undergoing cesarean section under spinal anesthesia were randomly allocated to receive 10 µg, 15 µg or 25 µg of intrathecal fentanyl with 10 mg of 0.5% hyperbaric bupivacaine. Patients were assessed for clinical efficacy by measuring pain score, need for rescue analgesia, conversion to general anesthesia and complaints of inadequacy of surgical anesthesia by the surgeon. The side effects assessed were pruritus, nausea, vomiting, dizziness, and decrease in saturation and respiratory rate. In addition neonatal Apgar score, patients’ hemodynamics, need for vasopressors, onset and duration of sensory and motor block were measured.
Results: Patients receiving 25 µg of fentanyl had a significantly higher incidence of pruritus, nausea, and dizziness in addition to a significantly prolonged sensory and motor block (P<0.001). All patients in three groups had adequate surgical anesthesia with no statistically significant difference in the onset of block, quality of surgical anesthesia, pain scores, neonatal Apgar score, hemodynamic variables and need for vasopressor.
Conclusion: 10 or 15 μg of intrathecal fentanyl with 10 mg of bupivacaine provided adequate surgical anesthesia and analgesia for patients undergoing cesarean section with minimal side effects
1. Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for caesarean section under spinal anaesthesia. Br J Anaesth 2002;89:452—458.
2. Seewal R, Shende D, Kashyap L, Mohan V. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: a dose-response study. Reg Anesth Pain Med 2007; 32:20-26.