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Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section

Published online by Cambridge University Press:  12 July 2005

A. de F. de Assunção Braga ,
F. S. da Silva Braga ,
G. M. Braga Potério ,
R. I. Costa Pereira ,
E. Reis  and
E. Cremonesi
A. de F. de Assunção Braga
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
F. S. da Silva Braga
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
G. M. Braga Potério
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
R. I. Costa Pereira
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
E. Reis
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
E. Cremonesi
Affiliation:
State University of Campinas (UNICAMP), Department of Anaesthesia, School of Medical Sciences, Campinas, São Paolo, Brazil
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Abstract

Summary

Background and objective: Subarachnoid block is a widely used technique for Caesarean section. Its quality can be improved by adding opioids to the local anaesthetics. We studied the quality of the block and its maternal–fetal repercussions when different doses of sufentanil were combined with hyperbaric bupivacaine using the intrathecal route in pregnant women undergoing Caesarean section.

Methods: This was a prospective, randomized, double-blind, controlled trial with 80 pregnant women, ASA I–II, who were scheduled for elective Caesarean section under subarachnoid block. Patients were distributed into four groups according to the dose of sufentanil used: no sufentanil (Group 1, control) or 2.5, or 5.0 or 7.5 μg sufentanil (Groups 2–4, respectively). In every group, the local anaesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg) and the total volume of the solution 4 mL. The onset time of the block, maximum level of sensory block, motor block level, duration of analgesia, maternal side-effects and maternal–fetal cardiovascular repercussions were evaluated.

Results: Onset of the block was significantly shorter in the groups receiving opioids compared with the control group. Analgesia was significantly prolonged in Groups 3 and 4. The occurrence of pruritus and somnolence was significantly higher in the group receiving sufentanil 7.5 μg than in other groups. With the exception of pruritus, no differences were observed between groups with respect to cardiovascular or other maternal effects.

Conclusions: The addition of sufentanil 5.0 and 7.5 μg to hyperbaric bupivacaine provided adequate anaesthesia for Caesarean section and good postoperative analgesia. Pruritus was the most common side-effect and had a significantly higher incidence when a dose of sufentanil 7.5 μg was used.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, spinalANAESTHETICS, LOCAL, bupivacaineANALGESICS, OPIOIDS, sufentanilOBSTETRIC SURGICAL PROCEDURES, Caesarean section, delivery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 8 , September 2003 , pp. 631 - 635
Copyright
2003 European Society of Anaesthesiology

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References

Dahl JB, Jeppesen IS, Jorgensen H, Wetterslev J, Moiniche S. 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.Google Scholar
Van Steenberger A. Epidural and subarachnoid opioids in labor and delivery: European view. In: Van Zundert A, Ostheimer GW, eds. Pain Relief Anesthesia in Obstetrics.New York, USA: Churchill Livingstone, 1996: 225–228.
Hunt CO, Naulty JS, Bader AM, et al. Perioperative analgesia with subarachnoid fentanyl bupivacaine for cesarean delivery. Anesthesiology 1989; 71: 535–540.Google Scholar
Courtney MA, Bader AM, Hartwell B, Hauch M, Grennan MJ, Datta S. Perioperative analgesia with subarachnoid sufentanil administration. Reg Anesth 1992; 17: 274–278.Google Scholar
Shende D, Cooper GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia 1998; 53: 706–710.Google Scholar
Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984; 61: 276–310.Google Scholar
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: 1288–1293.Google Scholar
Montgomery D. Design and Analysis of Experiments, 3rd edn. New York, USA: Wiley, 1991: 649.
Snyder SH. Opiate receptors and internal opiates. Sci Am 1977; 236: 44–56.Google Scholar
Camann WR, Minzter BH, Denney RL, Datta S. Intrathecal sufentanil for labor analgesia. Effects of added epinephrine. Anesthesiology 1993; 78: 870–874.Google Scholar
Takki S, Aromaa U, Kauste A. The validity and usefulness of end tidal PCO2 during anesthesia. Ann Clin Res 1972; 4: 278–284.Google Scholar
Van Gessel EF, Foster A, Schweizer A, Gamulin Z. Comparison of hypobaric, hyperbaric and isobaric solutions of bupivacaine during continuous spinal anesthesia. Anesth Analg 1991; 72: 779–784.Google Scholar
Kestin IG. Spinal anaesthesia in obstetrics. Br J Anaesth 1991; 66: 596–607.Google Scholar
Gomar C, Fernandez C. Epidural analgesia–anaesthesia in obstetrics. Eur J Anaesthesiol 2000; 17: 542–558.Google Scholar
Randalls B, Broadway JW, Browne DA, Morgan BM. Comparison of four subarachnoid solutions in a needle-through-needle technique for elective caesarean section. Br J Anaesth 1991; 66: 314–318.Google Scholar
Power I, Brown DT, Wildsmith JAW. The effect of fentanyl, meperidine, and diamorphine on nerve conduction in vitro. Reg Anesth 1991; 16: 204–208.Google Scholar
Gissen AJ, Gugino LD, Datta S, Miller J, Covino BG. Effects of fentanyl and sufentanil on peripheral mammalian nerves. Anesth Analg 1987; 66: 1272–1276.Google Scholar