Intrathecal Bupivacaine with Fentanyl versus Bupivacaine alone in Cases undergoing Elective Cesarean Section: Comparison of Hemodynamics

Abstract

Introduction: Fentanyl has been used in various doses intrathecally as an adjunct to local anesthesia in Cesarean section. It has been shown to increase the analgesic effect and prolong sensory blockade without increasing the side effects in the mother and the neonate. We conducted a study to compare hemodynamics of patients receiving 10 mcg fentanyl with 0.5% bupivacaine with those receiving bupivacaine alone.

Materials and Methods: Hundred women undergoing elective Cesarean section under spinal anesthesia were randomly divided into group F (fentanyl) and group C (control). Group F received 10 mcg of fentanyl with 2ml of 0.5% hyperbaric bupivacaine whereas Group C received 2.2ml of 0.5% hyperbaric bupivacaine. Hemodynamic parameters including blood pressure and heart rate, use of vasopressors, incidence of nausea, vomiting, pruritus, shivering, visceral pain, discomfort and neonatal outcome were recorded.

Results: There was similarity in incidence of hypotension and bradycardia before birth of baby between the two groups (Fentanyl group 69.39% vs Control group 66%, (p=0.830) and 0.02% vs 0.02%,p=1.00).The use of vasopressors (p=0.264), incidence of nausea, vomiting (p=0.318) and Apgar score at 1 and 5 minutes (p=0.919, p=0.952) were also not statistically significant. One patient in the fentanyl group complained of itching intraoperatively whereas four patients in each group complained of visceral pain during surgery. Two patients in fentanyl group experienced shivering intraoperatively.

Conclusion: Our study demonstrated that hemodynamic profile of patients undergoing elective Cesarean section under spinal anesthesia with use of 10 mcg fentanyl plus 0.5% hyperbaric bupivacaine was similar to those receiving hyperbaric bupivacaine alone.