Premixed versus sequential administration of intrathecal fentanyl and bupivacaine in elective caesarean section– A Comparative Study

Dr. Noopur Bansal; Dr. Sushma D. Ladi

Volume : VI, Issue : II, February - 2016

Premixed versus sequential administration of intrathecal fentanyl and bupivacaine in elective caesarean section– A Comparative Study

Dr. Noopur Bansal, Dr. Sushma D. Ladi

Abstract :

Background:The literature available suggests that the sequential use of the hyperbaric bupivacaine and opioid analgesics is more beneficial in the caesarean section than the premixed use. Hence, this study was undertaken with the intention of comparison of the premixed and sequential use of the hyperbaric bupivacaine and fentanyl. Materials and Methods: A randomized and single blinded study was conducted in the department of Anaesthesiology, Bharathi Vidyapeeth Deemed University, Pune. A total 30 patients were equally divided in to sequential group and premixed group. The hemodynamic changes, onset of sensory and motor block, side effects and regression of the motor and sensory block and duration of first rescue analgesia were studied between the sequential group and premixed group. Results:The mean age of patients was 25.4 (± 4.1) in the study group and 25.7 (± 3.4) years in control group. There was no significant difference in the blood pressure during the intra operative period. There was significant difference between the mean systolic and diastolic blood pressures of study and control groups at 1 min, 2 min, 3 min and 4 mins after induction of anesthesia. The mean (± SD) onset of sensory block in the study group was 2.7 (+/–0.53) mins and 5.03 (± 1.07) mins in the control group which was statistically significant. There was a statistically significant difference between the mean (± SD) time for onset of motor block in study group and control group. About 26.7% of the study group had itching as the common side effect and 23.3% of the control group had hypotension as the main side effect. The regression of the sensory block was at 173.5 (± 46.89) mins in the study group and at 116.5 (± 37.7) mins in the control group and which was statistically significant. The mean regression of the motor block was at 168.0 (± 34.9) mins in the study group and at 124.0 (± 41.5) mins in the control group which was also statistically significant. The time of rescue analgesia was at 189 (± 37.1) minutes in the study group and at 102.5 (± 32.0) minutes in the control group which was statistically significant. Conclusion:The lower incidence of side effects, stable hemodynamic effects and earlier onset and slower regression of the sensory and motor block favours the sequential use of hyperbaric bupivacaine and fentanyl.