Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial
ABSTRACT: Background: A number of different medications are used in combination with intrathecal bupivacaine for cesarean section anesthesia, but their relative efficacy has not been well established. Objective: To study the relative efficacy of adding either intrathecal fentanyl, intrathecal sufen...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Current Therapeutic Research |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0011393X22000273 |
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| author | Reza Jouybar, MD Zeinabsadat Fattahi Saravi, MD Nazi Dehghani, MD Sara Sadeghi, MD Sahar Chehelgerdi Samani, MD Zahra Esmaeilinezhad, MSc Farzaneh Masihi, MSc Naeimehosadat Asmarian, PhD |
| author_facet | Reza Jouybar, MD Zeinabsadat Fattahi Saravi, MD Nazi Dehghani, MD Sara Sadeghi, MD Sahar Chehelgerdi Samani, MD Zahra Esmaeilinezhad, MSc Farzaneh Masihi, MSc Naeimehosadat Asmarian, PhD |
| author_sort | Reza Jouybar, MD |
| collection | DOAJ |
| description | ABSTRACT: Background: A number of different medications are used in combination with intrathecal bupivacaine for cesarean section anesthesia, but their relative efficacy has not been well established. Objective: To study the relative efficacy of adding either intrathecal fentanyl, intrathecal sufentanil, or intravenous acetaminophen-morphine-fentanyl to intrathecal bupivacaine spinal anesthesia for pain control in elective cesarean section operations. Methods: In this randomized, double-blinded, controlled trial, 105 pregnant women eligible for cesarean section received 10 mg intrathecal bupivacaine (0.5%) in combination with 2 μg intrathecal sufentanil (group 1), 10 μg intrathecal fentanyl (group 2), and an intravenous cocktail of 1 g acetaminophen, 5 mg morphine, and 100 μg fentanyl (group 3). Patients were assessed for analgesia, time to block, and adverse effects. Results: The 3 groups were similar in terms of the time to onset of sensory block and the duration of both sensory and motor block. Groups 1 and 3 differed significantly in the time to peak sensory block, whereas group 1 differed significantly from groups 2 and 3 in the time to peak motor block. The sensory block level reached T4 in most patients. Significant differences in pain (visual analog scale) were demonstrated between groups 1 and 3 at 5 minutes after spinal injection, between groups 1 and 2 at the end of the surgery and upon arrival to the recovery room, and between all groups in the recovery room. Conclusions: When used in addition to 10 mg intrathecal bupivacaine, an intravenous cocktail of 1 g acetaminophen-5 mg morphine-100 μg fentanyl was as efficient as either 10 μg intrathecal fentanyl or 2 μg intrathecal sufentanil in terms of sensory and motor block duration and produced a higher dermatomal level of sensory block. However, intrathecal sufentanil provided better anesthesia quality (less time to onset of motor block and peak sensory-motor block) and better pain control. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX) |
| first_indexed | 2024-04-11T14:08:51Z |
| format | Article |
| id | doaj.art-1ba33e006dce47efbac74a021f41ab69 |
| institution | Directory Open Access Journal |
| issn | 0011-393X |
| language | English |
| last_indexed | 2024-04-11T14:08:51Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Therapeutic Research |
| spelling | doaj.art-1ba33e006dce47efbac74a021f41ab692022-12-22T04:19:48ZengElsevierCurrent Therapeutic Research0011-393X2022-01-0197100688Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical TrialReza Jouybar, MD0Zeinabsadat Fattahi Saravi, MD1Nazi Dehghani, MD2Sara Sadeghi, MD3Sahar Chehelgerdi Samani, MD4Zahra Esmaeilinezhad, MSc5Farzaneh Masihi, MSc6Naeimehosadat Asmarian, PhD7Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Address correspondence to: Zeinabsadat Fattahi Saravi, MD, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Postal Code: 71937-11351, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranDepartment of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranAnesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, IranABSTRACT: Background: A number of different medications are used in combination with intrathecal bupivacaine for cesarean section anesthesia, but their relative efficacy has not been well established. Objective: To study the relative efficacy of adding either intrathecal fentanyl, intrathecal sufentanil, or intravenous acetaminophen-morphine-fentanyl to intrathecal bupivacaine spinal anesthesia for pain control in elective cesarean section operations. Methods: In this randomized, double-blinded, controlled trial, 105 pregnant women eligible for cesarean section received 10 mg intrathecal bupivacaine (0.5%) in combination with 2 μg intrathecal sufentanil (group 1), 10 μg intrathecal fentanyl (group 2), and an intravenous cocktail of 1 g acetaminophen, 5 mg morphine, and 100 μg fentanyl (group 3). Patients were assessed for analgesia, time to block, and adverse effects. Results: The 3 groups were similar in terms of the time to onset of sensory block and the duration of both sensory and motor block. Groups 1 and 3 differed significantly in the time to peak sensory block, whereas group 1 differed significantly from groups 2 and 3 in the time to peak motor block. The sensory block level reached T4 in most patients. Significant differences in pain (visual analog scale) were demonstrated between groups 1 and 3 at 5 minutes after spinal injection, between groups 1 and 2 at the end of the surgery and upon arrival to the recovery room, and between all groups in the recovery room. Conclusions: When used in addition to 10 mg intrathecal bupivacaine, an intravenous cocktail of 1 g acetaminophen-5 mg morphine-100 μg fentanyl was as efficient as either 10 μg intrathecal fentanyl or 2 μg intrathecal sufentanil in terms of sensory and motor block duration and produced a higher dermatomal level of sensory block. However, intrathecal sufentanil provided better anesthesia quality (less time to onset of motor block and peak sensory-motor block) and better pain control. (Curr Ther Res Clin Exp. 2023; 84:XXX–XXX)http://www.sciencedirect.com/science/article/pii/S0011393X22000273acetaminophencesarean sectionfentanylspinal anesthesiasufentanil |
| spellingShingle | Reza Jouybar, MD Zeinabsadat Fattahi Saravi, MD Nazi Dehghani, MD Sara Sadeghi, MD Sahar Chehelgerdi Samani, MD Zahra Esmaeilinezhad, MSc Farzaneh Masihi, MSc Naeimehosadat Asmarian, PhD Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial Current Therapeutic Research acetaminophen cesarean section fentanyl spinal anesthesia sufentanil |
| title | Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial |
| title_full | Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial |
| title_fullStr | Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial |
| title_full_unstemmed | Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial |
| title_short | Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial |
| title_sort | comparative efficacy of 3 adjuvant medications used in combination with intrathecal bupivacaine for caesarian section anesthesia a randomized double blind clinical trial |
| topic | acetaminophen cesarean section fentanyl spinal anesthesia sufentanil |
| url | http://www.sciencedirect.com/science/article/pii/S0011393X22000273 |
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