Anesthetic quality during cesarean section following subarachnoid or epidural administration of bupivacaine with or without fentanyl

• Published in: Acta anaesthesiologica Scandinavica 1997-03, Vol.41 (3), p.332-338
• Main Authors: OLOFSSON, Ch, EKBLOM, A., SKÖLDEFORS, E., WÅGLUND, B., IRESTEDT, L.
• Format: Article
• Language: English
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adult; Analgesia; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics. Neuromuscular blocking agents; Apgar Score; Biological and medical sciences; Bupivacaine - administration & dosage; Cesarean Section; Double-Blind Method; epidural; Female; fentanyl; Fentanyl - administration & dosage; Humans; Infant, Newborn; Injections, Spinal; ketobemidone; Medical sciences; Monitoring, Physiologic; neo-nate; neonatal adaptive capacity score; Neuropharmacology; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Pregnancy; subarachnoid; Subarachnoid Space
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.1997.tb04694.x

Background: It is often assumed that subarachnoid administration of local anesthetics produces a more profound blockade than epidural anesthesia. Furthermore, the addition of fentanyl has been reported to increase preferentially intraoperative analgesia. In the present study we set out to study these two issues in a randomized and controlled study with respect to perceived pain and discomfort during surgery and postoperative pain. Methods: In the present study, 100 parturients subjected to elective cesarean section, 34 nullipara and 66 multipara, received one out of four combinations of the local anesthetic bupivacaine and the opioid fentanyl; group A ‐ bupivacaine 12.5 mg+10 μg fentanyl subarachnoidally, group B ‐ bupivacaine 12.5 mg+saline subarachnoidally, group C ‐ bupivacaine 100 mg+100 μg fentanyl epidurally, group D ‐ bupivacaine 100 mg+saline epidurally; N=25 in each group. Pain intensity and discomfort during surgery was assessed with a visual analogue scale (VAS). Postoperative pain intensity and need for analgesics postoperatively, ketobemidone, was registered for 24 h following surgery. Results: Intraoperative pain intensity and discomfort did not differ significantly between parturients in any of the four groups. Postoperative pain was significantly more intense in parturients receiving local anesthetics subarachnoidally as compared to the epidural groups during the first 6‐h period. This difference was also reflected in a significantly increased consumption of analgesics during this period. No significant differences between the groups were observed with regard to hemo‐dynamics (blood pressure), respiration (oxygen saturation) or other effects such as nausea or itching. All neonates had normal Apgar and neonatal adaptive capacity scores (NACS). Conclusion: We conclude that subarachnoidal (12.5 mg) and epidural (100 mg) injections with bupivacaine both produced adequate anesthetic quality in women undergoing elective cesarean section. The addition of fentanyl (10 μg subarachnoidally or 100 μg epidurally) did not significantly improve the quality of these already profound blockades.