The Maternal and Fetal Effects of the Addition of Sufentanil to 0.5% Spinal Bupivacaine for Cesarean Delivery

Background: Opioid added to local anesthetic for spinal anesthesia was first introduced into clinical practice in 1979 with intrathecal morphine as a forerunner. As morphine is water soluble and has prolonged action, late respiratory depression following spinal anesthesia is not infrequent and is the most serious complication that causes our concern. Sufentanil which is more hydrophobic than morphine also with shorter duration of action and quicker onset when injected into the subarchnoid space could be more effective and a safer drug as an adjuvant to local anesthetic in spinal anesthesia. Methods: Forty-one parturients who had given consent to spinal anesthesia for Cesarean delivery, were anesthetized with 12.5 mg of 0.5% bupivacaine alone or in combination with 10μg sufentanil in a randomized double blind manner. They were assigned either to C group (Control group) in which nothing is added to the local anesthetic and S group (Study group) in which sufentanil was added to the local anesthetic. Results: Perioperatively, hypotension occurred more in S group (17 against 11) but chest discomfort was less (3 against 7). Within 3 h after anesthesia 3 out of 19 parturients in S group requested analgesies but almost all parturients in C group did so. Conclusions: The addition of intrathecal sufentanil to 0.5% bupivacaine for spinal anesthesia improved perioperative discomfort and significantly reduced the demand of post-operative analgesia but on the other hands, it tended to increase perioperative hypotension and cause mild pruritus.

關鍵字

Delivery, Cesarean Section ； Bupivacaine ； Sufentanil

並列摘要

背景：臨床研究顯示，脊椎內使用局部麻醉劑併用所產生的協同作用可以改善手術期關的疼痛，潘武熙在1994年研究比較三種藥物的相等強度之劑量。這個回溯性的研究，其目的是比較三種藥物的止痛性質。研究指出在剖腹生產接受tetracaine脊椎麻醉的產婦10 μg sufentanil較alfentanil或fentanyl更有效的改善術中及術後疼痛。方法：以兩組剖腹生產之產婦，隨機分成兩組，在使用0.5% bupivacaine 12.5mg脊椎麻醉中，一組添加10 μg sufentanil，一組未添加任何藥物。觀察其疼痛情形有無改善及副作用的發生。結果：研究顯示在使用0.5% bupivacaine 12.5mg脊椎麻醉中加10 μg sufentanil藥物明顯改善疼痛情形。開刀後一小時內脊椎麻醉中沒有加10 μg sufentanil之病患中有十位發生疼痛情形，而用sufentanil組則不再加其它止痛劑。麻醉三小時內控制組有21個會發生疼痛情形，而用sufentanil組衹有3位需再加其它止痛劑。其副作用除了血壓下降和搔癢之外，其他呼吸抑制、噁心、嘔吐、眩暈等與控制組相較沒有明顯差異。結論：綜和以上研究得知，bupivacaine腰椎麻醉裡添加10 μg sufentanil有止痛效果，亦無重大副作用，此方法合併使用有助益於臨床的使用，但應注意低血壓之副作用。

並列關鍵字

剖腹生產； Bupivacaine ； Sufentanil

國際替代計量

The Maternal and Fetal Effects of the Addition of Sufentanil to 0.5% Spinal Bupivacaine for Cesarean Delivery

全文下載

主題瀏覽