Comparing the Conventional with Low Dose of Bupivacaine Plus Fentanyl in Spinal Aneﬆhesia on the Neonate Apgar Score in Yazd City
Introduction: Spinal anesthesia is the preferred method of anesthesia in cesarean section, due to less complications. The augmentation of opioids to spinal anesthetics can improve the quality and increase the duration of analgesia. This study aimed to compare the conventional with low dose of bupivacaine plus fentanyl in spinal anesthesia on the neonate Apgar score in elective cesarean section. Methods: The present double-blind randomized clinical trial was conducted on 150 pregnant mothers undergoing cesarean section with the spinal anesthesia during 2017-2018. The mothers were randomly assigned to two groups of 75. The spinal anesthesia was performed in the first group with the injection of 15 mg of 0.5% hyperbaric bupivacaine plus 1 ml of normal saline, and in the second group with the injection of 12.5 mg of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. For both groups, 1- and 5-minute neonatal Apgar scores were assessed. Finally, the data were analyzed by SPSS17 software using statistical tests. Results: The mean age of the samples was 30.1±5.19 years with a range of 18-42 years (P-value=0.246). The mean gestational age was 38 weeks, the mean 1-minute Apgar score was 8.88 and the mean 5-minute Apgar score was 9.89. Conclusion: With the augmentation of fentanyl to bupivacaine for spinal anesthesia, the conventional dose can be reduced, which not only reduces the common side effects of Marcainee, but also provides an appropriate level of anesthesia and does not affect the neonatal Apgar score.
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obﬆetrics. 23rd ed. New York: Mc-Graw-Hill;2010:544-62.
Matthey PW, Finegan BA, Finucane BT: The public’s fears about and perceptions of regional aneﬆhesia. Reg Aneﬆh Pain Med. 2004;29(2):96–101.
Birnbach DJ, Browne IM. Aneﬆhesia for obﬆetrics. In: Miller RD. Miller’s aneﬆhesia. 7th ed. Philadelphia: Churchill Living
Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated syﬆematic review. Am J Obﬆet Gynecol. 2013;209(4): 294-306.
American College of Obﬆetricians and Gynecologiﬆs: Fetal monitoring prior to scheduled cesarean delivery. 2010;382.
Dailey PA. Fisher DM, Schnider SM, et al. Pharmacokinetics,-placental transfer and neonatal eﬀects of vecuronium and pancu-ronium adminiﬆered during cesarean section. Aneﬆhesiology. 1984;60(6):569-74.
Basuni AS. Addition of low-dose ketamine to midazolam and low-dose bupivacaine improves hemodynamics and poﬆoperative analgesia during spinal aneﬆhesia for cesarean section. J Anaeﬆhe-siol Clin Pharmacol. 2016;32(1):44.
Wahi A, Singh AK, Syal K, Sood A, Pathania J. Comparative Eﬃ-cacy of Intrathecal Bupivacaine Alone and Combination of Bupiva-caine with Clonidine in Spinal Anaeﬆhesia. JCDR. 2016;10(4):06.
Freedman JM, Li DK, Drasner K, Jaskela MC, Larsen B, Wi
S. Transient Neurologic Symptoms after Spinal AneﬆhesiaAn Epidemiologic Study of 1,863 Patients. J Am Soc Aneﬆhesiol. 1998;89(3):633-41.
Choi DH, Ahn Hj, Kim MH. Bupivacaine – sparing eﬀect of fentanyl in spinal aneﬆhesia for cesarean delivery. Reg Aneﬆh Pain Med. 2000;25(3):40-5.
Apgar V. A proposal for a new method of evaluation of the newborn. Classic Papers in Critical Care. 1952;32(449):97.
Santhosh MC, Bidikar M, Mudakangoudar MS. Comparison of intrathecal levobupivacaine and levobupivacaine plus fentanyl for cesarean section..
Yousef AA, Salem H.A, Mouﬆafa M.Z. Eﬀect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural aneﬆhesia: a randomized double-blinded controlled ﬆudy. J Aneﬆh. 2015;29(5):708-14.
Zirak N, Haﬁzi L, Eftekharzadeh S, Ghomian N, Moradifar M. Evaluating the eﬀect of regular dose plus fentanyl in spinal anesthesia of elective cesarean section on neonatal apgar score and time of sensory-block regression. IJOGI. 2012;15(20):12-8.
Rasooli S, Moslemi F. Comparison of prophylactic infusion of phenylephrine with ephedrine for prevention of hypotension in elective cesarean section under spinal aneﬆhesia: a randomized clinical trial. IJMS. 2015;40(1):19.
Nair G, Abrishami A, Lermitte J, Chung F. Syﬆematic review of spinal aneﬆhesia using bupivacaine for ambulatory knee arthros-copy. Br J Anaeﬆh. 2009;102:307-15.
Sanli S, Yegin A, Kayacan N, Yilmaz M, Coskunﬁrat N, Karsli
B. Eﬀective of hyperbaric spinal ropivacaine for ceesarean section: with or with out fentanyl. Eur J Anaeﬆhesiol. 2005;22(6):457-61.
Jain K, Grover V, Mahajan R, Batra YK. Eﬀect of verying doses of fentanyl with low doses spinal bupivacaine for cesarean delivery in patient with pregnancy-induced hypertention. J Obﬆet Aneﬆh. 2004;13(4):215-20.
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