Intrathecal Administration of Fentanyl with Hyperbaric Bupivacaine either a Mixture or Sequentially in Elective Cesarean Section: A Randomised Single Blind Study UC06-UC10
B-40, IInd Floor, Parshwanath City, Sangariya, Jodhpur, Rajasthan, India.
Introduction: Effect of adjuvant drug’s density on local anaesthetic agent’s movement in CSF has not been studied extensively which may affect the onset, level and quality of spinal anaesthesia.
Aim: To compare intrathecal fentanyl with hyperbaric bupivacaine as either a mixture or sequentially in elective cesarean section under spinal anaesthesia.
Materials and Methods: A randomised, controlled, comparative study was done on 160 parturients scheduled for elective cesarean section from December 2018 to March 2019. Parturients were randomly allocated in to two groups M and S, each having 80 parturients. Group M parturients received 7.5 mg bupivacaine heavy (0.5%) premixed with 25 μg fentanyl in the same syringe as spinal anaesthetic agents. Group S parturient received 25 μg fentanyl in the first syringe and 7.5 mg bupivacaine 0.5% in the second syringe without barbotage. Both groups were compared for block characteristics, haemodynamic changes, duration of analgesia (primary outcome) and fetal outcome, side effects (secondary outcome). Statistical analysis was done using unpaired t-test, chi square test, Fisher-exact test. The level of significance was taken as p-value <0.05.
Results: Hypotension was recorded in 30 patients (37.50%) in group M and 18 patients (22.5%) in group S without significant difference. However, early hypotension at 3 minutes and 6 minutes was significantly higher in group M 25 patients (31.25%) than group S (8 patients, 10%). No significant difference of onset time of sensory, motor block was found between the groups. Time to reach the highest level of sensory and motor block was higher in group M (p<0.05). Duration of motor block and time of 1st dose of analgesic required (p<0.0001) were significantly higher in group S.
Conclusion: Two syringe techniques of fentanyl and hyperbaric bupivacaine provide better quality of sensory block without incidence of hypotension and provide prolonged post-operative analgesia as compared to one syringe technique.