Analgesic Effects of Intrathecal Sufentanil Added to Lidocaine 5% in Elective Cesarean Section
-
Mohammad Hosein Bakhshaei
,
Nahid Manuchehrian
,
Ebrahim Khoshraftar
,
Hassan Mohamadipour-Anvary
,
Mehdy Sanatkarfar
Abstract
The quality of subarachnoid block can be improved by adding opioids to the local anesthetics. We compared the analgesic effects of different doses of intrathecal sufentanil added to lidocaine %5 for elective cesarean section. This study was a prospective, randomized, double-blind, controlled trial. 90 pregnant women with ASA class I-II, scheduled for elective cesarean section under spinal anesthesia were enrolled in this study. Three groups were made of them by random; Group 1 (control group) was given lidocaine 5% (75 mg) and 2 ml of normal saline. Patients in Group 2 received lidocaine 5% (75 mg) and 5 micrograms sufentanil plus 1ml normal saline. Group 3 patients received lidocaine 5% (75 mg) and 10 micrograms sufentanil. Duration of sensory block and effective analgesia (need to analgesic) were measured. Opioid related side effects were recorded. Duration of sensory block and effective analgesia were prolonged in sufentanil groups in comparison of control group(50.3±4) that was significantly more in group3 (128 ± 4) versus group 2 (58.3 ± 10)(P < 0.001) . There was mild to moderate respiratory depression in sufentanil groups which was more noted in group 3 (p < 0.001). No differences were detected in other side effects such as hypotension, nausea & vomiting. The addition of sufentanil 10 versus 5 micrograms to lidocaine 5% provided more duration of analgesia for cesarean delivery. So, the adding of 10 micrograms sufentanil to lidocaine 5% for cesarean section has more effective analgesia with minimum side effects.
Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for cesarean delivery. Anesthesiology 1989;71(4):535-40.
Randalls B, Broadway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needlethrough- needle technique for elective caesarean section. BrJ Anaesth 1991;66(3):314-8.
Courtney MA, Bader AM, Hartwell B, Hauch M, Grennan MJ, Datta S. Perioperative analgesia with subarachnoid sufentanil administration. Reg Anesth 1992;17(5):274-8.
Lee JS. Does intrathecal sufentanil really cause more= episodes of fetal bradycardia? Anesth Analg 2004;99(4):1267; author reply 1267.
Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 1997;85(6):1288-93.
Bromage PR, Burfoot MF, Crowell DE, Pettigrew RT. Quality of epidural blockade. I. Influence of physical factors. Br J Anaesth 1964;36:342-52.
Van Decar T, Callicot R, Jones R, Herman N. Determination of a dose response curve for intrathecal sufentanil in labor. Anesthesiology 1994;81:A1148.
Abouleish A, Camann W, Holden D. Antinociceptive interaction between intrathecal sufentanil and epidural bupivacaine: additivity or synergism? Anesthesiology 1994;81:A1144.
Chadwick HS, Ready LB. Intrathecal morphine sulfate for post-Cesarean analgesia: a clinical comparison. Anesthesiology 1988;68(6):925-9.
Abouleish E, Rawal N, Fallen K, Hernandez D. Combined intrathecal morphine and bupivacaine for Cesarean section. Anesth Analg 1988;67(4):370-4.
Connely NR, Dunn SM, Ingold V, Villa EA. The use of fentanyl added to morphine-lidocaine-epinephrine spinal solution in patients undergoing Cesarean section. Anesth Analg 1994;78(5):918-20.
Karaman S, Kocabas S, Uyar M, Hayzaran S, Firat V. The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol 2006;23(4):285-91.
Hansdottir V, Hedner T, Woestenborghs R, Nordberg G. The CSF and plasma pharmacokinetics of sufentanil after intrathecal administration. Anesthesiology 1991;74(2):264-9.
Leysen JE, Gommeren W. In vitro binding properties of 3H-sufentanil, a superior ligand for the mu-opiate receptor. Arch Int Pharmacodyn Ther 1982;260(2):287-9.
Qian XW, Chen XZ, Li DB. Low-dose ropivacainesufentanil spinal anaesthesia for caesarean delivery: arandomised trial. Int J Obstet Anesth 2008;17(4):309-14.
Bremerich DH, Fetsch N, Zwissler BC, Meininger D, Gogarten W, Byhahn C. Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section. Curr Med Res Opin 2007;23(12):3047-54.
Bremerich DH, Fetsch N, Zwissler BC, Meininger D,Gogarten W, Byhahn C. Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section. Curr Med Res Opin 2007;23(12):3047-54.
Frikha N, Ellachtar M, Mebazaa MS, Ben Ammar MS. Combined spinal-epidural analgesia in labor: comparison of sufentanil vs tramadol. Middle East J Anesthesiol 2007;19(1):87-96. Wang LZ, Zhang YF, Tang BL, Yao KZ. Effects of intrathecal and i.v. small-dose sufentanil on the median effective dose of intrathecal bupivacaine for Caesarean section. Br J Anaesth 2007;98(6):792-6.
Schug SA, Saunders D, Kurowski I, Paech MJ. Neuraxial drug administration: a review of treatment options for anaesthesia and analgesia. CNS Drugs 2006;20(11):917- 33. Review. Erratum in: CNS Drugs 2007;21(7):579.
Asehnoune K, Larousse E, Tadié JM, Minville V, Droupy S, Benhamou D. Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia. Anesth Analg 2005;101(5):1512-5.
Demiraran Y, Ozdemir I, Kocaman B, Yucel O. Intrathecal sufentanil (1.5 microg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy. J Anesth 2006;20(4):274-8.
Breen TW, Giesinger CM, Halpern SH. Comparison of epidural lidocaine and fentanyl to intrathecal sufentanil for analgesia in early labour. Int J Obstet Anesth 1999;8(4):226-30.
| Files | ||
| Issue | Vol 48, No 6 (2010) | |
| Section | Articles | |
| Keywords | ||
| Sufentanil cesarean section pain anesthesia spinal | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
