Anaesthetic efficacy of low dose bupivacaine with fentanyl for caesarean section - a randomised control trial

Priya Ramakrishnan; Anandhi Arul

Volume : IX, Issue : III, March - 2019

Anaesthetic efficacy of low dose bupivacaine with fentanyl for caesarean section - a randomised control trial

Priya Ramakrishnan, Anandhi Arul

Abstract :

Background : A ‘good quality block’ for Caesarean section should combine adequate intraoperative anaesthesia with minimal side effects .Low dose bupivacaine has been advocated to reduce incidence of hypotension but has raised concerns of poor anaesthetic efficacy .With its rapid onset of action ,intrathecal fentanyl could augment quality of anaesthesia in the intraoperative period .In this randomised controlled study we evaluated the anaesthetic efficacy of combining optimal hemodynamic dose of 7.5 mg hyperbaric bupivacaine with the intrathecal fentanyl as compared to the conventional dose of 12.5mg of bupivacaine. Methods: 100 singleton parturients scheduled for elective caesarean section were randomly allocated into two groups. The study group received a combination of 25 µg fentanyl, 0.5ml saline and 7.5 mg of hyperbaric bupivacaine, whereas the control group received 12.5 mg of hyperbaric bupivacaine. Intraoperative patient comfort, adequacy of sensory and motor block, hemodynamics, side effects, duration of blockade and analgesia and the Apgar score of the new–born were compared between the groups. Results: Anaesthetic efficacy was better in the Fentanyl group with only 4.1% patients requiring intraoperative supplementation as compared to 16.3% in the control group. Also 14.3% patients in control group had nausea vomiting but none in the fentanyl group. Hypotensive episodes and need for ephedrine was less in fentanyl group (18.4%) versus control group (46.9%). Conclusion: Intrathecal low dose bupivacaine with fentanyl in Caesarean section provides good intraoperative anaesthesia, stable hemodynamics and a satisfied pain free mother in the postoperative period.