Download PDF
Drug Res (Stuttg) 2015; 65(09): 468-472
DOI: 10.1055/s-0034-1387740
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Comparative Evaluation of Intrathecal Bupivacaine Alone, Bupivacaine-fentanyl, and Bupivacaine-dexmedetomidine in Caesarean Section

Y. Sun
1   Department of Anesthesia, Heilongjiang Province Hospital, Harbin, Heilongjiang Province, China
,
Y. Xu
2   Department of Anesthesia, The Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
,
G.-N. Wang
2   Department of Anesthesia, The Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
› Author Affiliations
Further Information

Publication History

received 16 July 2014

accepted 01 August 2014

Publication Date:
10 September 2014 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose: In this study, we aimed to compare the effects of bupivacaine alone, bupivacaine plus fentanyl, and bupivacaine plus dexmedetomidine for postoperative analgesia in women undergoing cesarean section under spinal anesthesia.

Material and methods: 90 term parturients scheduled to have elective cesarean section and ASA physical status I or II were allocated randomly into 3 groups to receive either bupivacaine (Bv group) or bupivacaine plus fentanyl (BvF group) or bupivacaine plus dexmedetomidine (BvD group). The onset time of sensory block, maximum sensory block level, duration of motor and sensory block, onset of post-operative pain, sedation scores, Apgar scores and side effects were recorded and statistically compared across 3 groups.

Results: Regression time to T10 was significantly longer in BvD group, sensory block was also prolonged in BvD group without any difference in duration of motor block. Onset of post-operative pain was delayed in BvD group. Sedation scores (VAS) were improved in case of BvD with least values of 0–3 followed by BvF (1–4). There was no significant difference in Apgar scores and neonatal arterial gas pressures across 3 groups.

Conclusion: The use of dexmedtomidine as an adjuvant to bupivacaine in cesarean surgeries provides better intra-operative and post-operative analgesia without having significant impact on Apgar scores or incidence of side effects.

Key words

bupivacaine - fentanyl - dexmedetomidine - post-operative analgesia - cesarean section - sensory block - motor block
 

  • References

  • 1 Braga AFA, Braga FSB, Potério B et al. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003; 20: 631-635
    CrossrefPubMedGoogle Scholar
  • 2 Gupta R, Verma R, Bogra J et al. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. Journal of Anaesthesiology Clinical Pharmacology 2011; 27 () 339-344
    CrossrefPubMedGoogle Scholar
  • 3 Rubin AP. Spianal anesthesia, Em. Wildsmith JA. (ed.). Principles and Practice of Regional Anesthesia. London, UK: Churhill Livingstone; 1998: 70-80
    Google Scholar
  • 4 Covino BG. Rationale for spinal anesthesia. International Anesthesiology Clinics. 1989; 27: 8-12
    CrossrefPubMedGoogle Scholar
  • 5 Carter J, Macarthur A. Spinal anesthesia for Caesarean section. Contemporary Anesthesia 1994; 4: 11-15
    PubMedGoogle Scholar
  • 6 Hunt CO, Dutta S, Hauch M. Perioperative analgesia with subarachnoid fentanyl bupivacaine. Anaesthesiology 1987; 67
    PubMedGoogle Scholar
  • 7 Sapate M, Sahu P, Thatte WS et al. A randomized, double blind, control study of the effects of adding nalbuphine to spinal bupivacaine for lower abdominal surgeries in elderly patients. Anaesth, Pain & Intensive Care 2013; 17. 2: 145-148
    PubMedGoogle Scholar
  • 8 Shetty PS, Picard J. Adjuvant agents in regional anaesthesia. Anaesth Intensive Care Med 2006; 7: 407-410
    CrossrefPubMedGoogle Scholar
  • 9 Alahuhta S, Kangas-Saarela T, Hollmén AI et al. Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesthesiol Scand 1990; 34: 95-98
    CrossrefPubMedGoogle Scholar
  • 10 Etches RC, Sandler AN, Daley MD. Respiratory depression and spinal opioids. Can J Anaesth 1989; 36: 165-185
    CrossrefPubMedGoogle Scholar
  • 11 Al-Ghanem SM, Massad IM, Al-Mustafa MM et al. Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study. Am J Appl Sci. 2009. 6. 882-887
    Google Scholar
  • 12 Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedure. Saudi Med J 2009; 30: 365-370
    PubMedGoogle Scholar
  • 13 Kanazi GE, Aouad MT, Jabbour-Khoury SI et al. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anesthesiol Scand 2006; 50: 222-227
    CrossrefPubMedGoogle Scholar
  • 14 Robinson JO, Rosen M, Evans JM et al. Maternal opinion about analgesia for labor. A controlled trial between epidural block and intramuscular pethidine combined with inhalation. Anaesthesia 1980; 35: 1173-1181
    CrossrefPubMedGoogle Scholar
  • 15 Thorp JA, Hu DH, Albin RM et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol 1993; 169: 851-858
    CrossrefPubMedGoogle Scholar
  • 16 Ishii H, Kohno T, Yamakura T et al. Action of dexmedetomidine on the substantia gelatinosa neurons of the rat spinal cord. Eur J Neurosci 2008; 27: 3182-3190
    CrossrefPubMedGoogle Scholar
  • 17 Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anesthesiol 2008; 21: 457-461
    CrossrefPubMedGoogle Scholar
  • 18 Vercauteren M. Obstetric spinal analgesia and anesthesia. Curr Opin Anaesthesiol 2003; 16: 503-507
    CrossrefPubMedGoogle Scholar
  • 19 Dahlgren G, Hultstrand C, Jakobsson J et al. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 1997; 85: 1288-1293
    PubMedGoogle Scholar
  • 20 Bremerich DH, Fetsch N, Zwissler BC et al. Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section. Curr Med Res Opin 2007; 23: 3047-3054
    CrossrefPubMedGoogle Scholar
  • 21 Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999; 24: 255-263 improves analgesia during cesarean section. Anesth Analg 1998; 87: 609-613
    CrossrefPubMedGoogle Scholar
  • 22 Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol 2005; 5: 5
    CrossrefPubMedGoogle Scholar
  • 23 Dahl JB, Jeppesen IS, Jørgensen H et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 1999; 91: 1919-1927
    CrossrefPubMedGoogle Scholar
  • 24 Kalso E, Poyhia R, Rosemberg P. Spinal antinociceptive by dexmedetomidine, a highly selective 2-adrenergic agonist. Pharmacol Toxicol 1991; 68: 140-143
    CrossrefPubMedGoogle Scholar
  • 25 Karaman S, Kocabas S, Uyar M et al. The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol 2006; 23: 285-291
    CrossrefPubMedGoogle Scholar
  • 26 Sibilla C, Albertazzi P, Zatelli R et al. Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination. Int J Obstet Anesth 1997; 6: 43-48
    CrossrefPubMedGoogle Scholar
  • 27 Dresner MR, Freeman JM. Anaesthesia for caesarean section. Best Pract Res Clin Obstet Gynaecol 2001; 15: 127-143
    CrossrefPubMedGoogle Scholar
  • 28 Gogarten W. Spinal anaesthesia for obstetrics. Best Pract Res Clin Anaesthesiol 2003; 17: 377-392
    CrossrefPubMedGoogle Scholar
  • 29 Chestnut DH. Anesthesia and maternal mortality. Anesthesiology 1997; 86: 273-276
    CrossrefPubMedGoogle Scholar
  • 30 McKinlay J, Lyons G. Obstetric neuraxial anaesthesia: which pressor agents should we be using. Int J Obst Anaesth 2002; 11: 117-121
    PubMedGoogle Scholar
  • 31 Lee A, Kee WDN, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for Cesarean delivery. Anesth Analg 2002; 94: 920-926
    CrossrefPubMedGoogle Scholar
  • 32 Paech MJ, Pavy TJG, Orlikowski CEP et al. Postcesarean analgesia with spinal morphine, clonidine, or their combination. Anesth Analg 2004; 98: 1460-1466
    PubMedGoogle Scholar
  • 33 Benhamou D, Thorin D, Brichant JF et al. Intrahecal clonidine and fentanyl with hyperbaric bupivacaine.
    PubMedGoogle Scholar
  • 34 Taittonen MT, Kirvelä OA, Aantaa R et al. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth 1997; 78: 400-406
    CrossrefPubMedGoogle Scholar
  • 35 Salgado PF, Nascimento P, Mo’dolo NS et al. Adding dexmedetomidine to ropivacaine 0.75% for epidural anesthesia. Does it improve the quality of the anesthesia? Anesthesiology 2005; 103: A974
    PubMedGoogle Scholar
  • 36 Neumann MM, Davio MB, Macknet MR et al. Dexmedetomidine for awake fiberoptic intubation in a parturient with spinal muscular atrophy type III for cesarean delivery. Int J Obstet Anesth 2009; 18: 403-407
    CrossrefPubMedGoogle Scholar
  • 37 Palanisamy A, Klickovich RJ, Ramsay M et al. Intravenous dexmedetomidine as an adjunct for labor analgesia cesarean delivery anesthesia in a parturient with a tethered spinal. Int J Obstet Anesth 2009; 18: 258-261
    CrossrefPubMedGoogle Scholar
  • 38 Abu-Halaweh SA, Al Oweidi AK, Abu-Malooh H et al. Intravenous dexmedetomidine infusion for labour analgesia in patient with preeclampsia. Eur J Anaesthesiol 2009; 26: 86-87
    CrossrefPubMedGoogle Scholar