Fauzia Bano, Saleem Sabbar, Safia Zafar, Nabeela Rafeeq, Mirza Nasir Iqbal, Saeeda Haider, Sadqa Aftab, Tipu Sultan.
Intrathecal Fentanyl as adjunct to hyperbaric Bupivacaine in spinal anesthesia for Cesarean section.
J Coll Physicians Surg Pak Jan ;16(2):87-90.

Objective: To compare the effect of adding fentanyl to intrathecal bupivacaine on the onset, duration and quality of spinal anesthesia and its effect of mother and neonate. Design: Single blind randomized controlled clinical trial. Place and Duration of Study: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from January 2003 to June 2004. Patients and Methods: Sixty young adult females, ASA physical status I and II, with singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive spinal anesthesia either by using 0.75% hyperbaric bupivacaine 1.5ml with 0.25ml normal saline or 0.75% hyperbaric bupivacaine 1.5ml with 0.25 ml fentanyl (12.5mg). Blood pressure, heart rate, respiratory rate, oxygen saturation, sensory level, motor block, pain score and side effects were observed every 2 minutes for first 20 minutes, then at-5 minute interval throughout the surgery, thereafter at 30 minutes interval until the patient complained of pain. Results: Comparing the bupivacaine group, time to achieve highest sensory level was significantly shorter in fentanyl group (*p<0.05), while the duration of complete analgesia (time from injection to first report of pain) lasted significantly more longer in fentanyl group (184±20 minutes) than bupivacaine group (126±10 minutes). Duration of effective analgesia was also significantly more prolonged in fentanyl group (p<0.05). There was no significant difference in the incidence of side effects between the two groups. Conclusion: Addition of fentanyl to intrathecal bupivacaine results in faster onset with improved peri-operative anesthesia without increasing the side effects.

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