The Effect of Intrathecal Bupivacaine with Combined Fentanyl in Cesarean Section

Background: The use of neuraxial opioids has gained popularity over the last few years; they may augment the analgesia produced by the local anesthetic through direct binding with the specific spinal receptors. Morphine, a lipophobic opioid, may not be optimal as an intrathecal drug for intraoperative analgesia because of its slow onset. The lipophilic opioid, fentanyl for instance, if administered intrathecally, its onset is fast and many of its merits by virtue of its lipophilic property may be seen intraoperatively. Methods: Seventy five healthy pregnant women who sustained cesarean section under spinal anesthesia were assessed in a randomized fashion. The spinal anesthetic used was 0.5% hyperbaric bupivacaine. Patients were divided into 5 groups, 15 in each group. Fentanyl 0 (Group I), 7.5 (Group II), 10 (Group III), 12.5 (Group IV) and 15 (Group V) μg was respectively added to normal saline to make a total volume of 0.3 ml, which was then added to bupivacaine and administered to patients in a randomized fashion. The effect of analgesia, vital signs and side effects were observed every 5 min during operation and every 30 min after operation. Results: It was disclosed that all patients in group V and IV had excellent analgesia intraoperatively, while only 33.3% patients in the control group had an analgesia which was qualified as excellent. Complete analgesia (time from injection to first report of pain) also lasted longer in group IV (201.3 ± 16.4 min, mean ± SEM) and group V (210.3 ± 18.6 min) compared with group I (118.9 ± 10.4 min). The duration of effective analgesia (time from injection to first parental opioid) was increased with the dose of intrathecal fentanyl above 12.5 μg (293 ± 22.4 min). Both complete analgesia and effective analgesia were not significantly different between group IV and group V. Pruritus was the most common side effect. The incidence of shivering decreased significantly in group IV & V as compared with control group. Conclusions: The combination of bupivacaine with a dose of fentanyl as low as 7.5 μg did not produce actual clinical effects. As the dose of fentanyl was increased to 12.5 μg or 15 μg the quality of surgical analgesia was better and the postoperative analgesia lasted longer. It seemed that the clinical effect might reach its ceiling at the dose of 12.5 μg. Pruritus was the most common side effect, but it was mild.

關鍵字

Intrathecal fentanyl ； Cesarean section ； Analgesia

並列摘要

背景：親脂性之類嗎啡，如fentanyl，若是經由蛛網膜下腔投予，其起始作用時間較親水性之morphine為快，因此若fentanyl合併局部麻醉藥使用，則在手術當中即可顯見其臨床效果。方法：此研究觀察4種不同劑量的fentanyl於0.5%之高比重bupivacaine的手術中與手術後之效果。本實驗涵蓋了75位欲接受腰椎麻醉行常規剖腹產之健康產婦，隨機分為五組。每組15人，第一組於局部麻藥當中加入0.3毫升之生理食鹽水；第二組至第五組，則分別加入fentanyl 7.5, 10, 12.5及15微克。爾後每五分鐘偵測其麻醉效果，術後止痛時間，生命現象及副作用。結果：實驗結果顯示第四，五組的手術中之止痛效果佳及術後止痛時間最間長。皮膚發癢是最常見之副作用，但皆很輕微。在接受fentanyl之四組，其發抖之副作用之機率依劑量之增加而減少，以第四，五兩組最具統計上的意義。結論：我們認為在剖腹產的手術中使用bupivacaine合併低劑量如7.5微克之fentanyl麻醉並不具實際臨床效果，但fentanyl劑量達12.5或15微克時，則麻醉效果佳及術後之止痛延長，僅有輕微之副作用，且更有降低發抖機率之好處。

並列關鍵字

剖腹產；腰椎麻醉；蛛網下腔； Bupivacaine合併fentanyl

國際替代計量

The Effect of Intrathecal Bupivacaine with Combined Fentanyl in Cesarean Section

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