Venkata Himabindu Gandam, Pasupuleti Surender, Pabba Upender Gowd, Porika Sridevi, Talari Goutham
Department of Anesthesiology and Critical Care, Gandhi Medical College/Hospital, Secunderabad, Telangana, India.
Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA.
Saudi J Anaesth. 2015 Apr-Jun;9(2):122-7. doi: 10.4103/1658-354X.152827.
Hormonal and mechanical factors make obstetric patients need strict dose calculations of local anesthetics intrathecally for spinal anesthesia. Any greater dose of local anesthetics can cause hemodynamic instability, maternal morbidity and any lesser dose can produce inadequate block. Hence, we hypothesized in our study that by using low dose of bupivacaine with fentanyl can maintain stable hemodynamics and provide better analgesia.
The aim was to compare the hemodynamics and duration of analgesia using a low dose (7.5 mg) bupivacaine fentanyl mixture to a conventional dose (10 mg) of hyperbaric bupivacaine for cesarean section.
Double-blinded, randomized, controlled prospective study was conducted at a tertiary academic hospital from 2008 to 2011.
Fifty singleton parturient, scheduled for elective caesarean section were randomly allocated into two groups. Study group (group-S) received a combination of 25 μg fentanyl and 7.5 mg of hyperbaric bupivacaine, whereas the control group (group-C) received 10 mg of hyperbaric bupivacaine. Maternal hemodynamics, sensory and motor block, duration of analgesia and the Apgar score of the newborn were compared between the groups.
Observational descriptive statistics, statistical package for social sciences (SPSS Inc. Released 2006, SPSS for Windows, Version 15.0. Chicago), paired t-test was used as applicable.
The blood pressure significantly decreased with >25% fall from the baseline in group-C (98.76 ± 8.36) than in group-S (117.32 ± 12.21) with P < 0.001. The duration of effective analgesia was significantly prolonged in the study group than in the control group (P < 0.001).
The combination of low dose bupivacaine and fentanyl in comparison to bupivacaine alone is hemodynamically stable and prolonged duration of analgesia in caesarean section.
激素和机械因素使得产科患者在进行脊髓麻醉时鞘内注射局部麻醉药需要严格计算剂量。局部麻醉药剂量过大可导致血流动力学不稳定和产妇发病，而剂量过小则可能导致阻滞不全。因此，我们在研究中假设，使用低剂量布比卡因联合芬太尼可维持血流动力学稳定并提供更好的镇痛效果。
比较低剂量（7.5毫克）布比卡因芬太尼合剂与传统剂量（10毫克）的重比重布比卡因用于剖宫产时的血流动力学和镇痛持续时间。
2008年至2011年在一家三级学术医院进行了双盲、随机、对照前瞻性研究。
50名单胎产妇，计划进行择期剖宫产，随机分为两组。研究组（S组）接受25微克芬太尼与7.5毫克重比重布比卡因的合剂，而对照组（C组）接受10毫克重比重布比卡因。比较两组产妇的血流动力学、感觉和运动阻滞、镇痛持续时间及新生儿阿氏评分。
观察性描述性统计，使用社会科学统计软件包（SPSS公司，2006年发布，适用于Windows的SPSS，版本15.0，芝加哥），适当时使用配对t检验。
C组（98.76±8.36）血压较基线显著下降>25%，高于S组（117.32±12.21），P<0.001。研究组有效镇痛持续时间显著长于对照组（P<0.001）。
与单独使用布比卡因相比，低剂量布比卡因与芬太尼联合使用在剖宫产时血流动力学更稳定，镇痛持续时间更长。
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