Analgesic Effect of Intrathecal Fentanyl as an Adjuvant to Spinal Anaesthesia in Comparison with Spinal Anaesthesia with Bupivacaine Only for Mothers Delivered by Emergency Cesarean Section

Abstract

Background: Pain during cesarean section is a common phenomenon which results release of stress hormone during surgery. In contrast, effective analgesia may permit improved mother-child bonding, early ambulation, discharge, greater patient satisfaction and early breastfeeding. Now a days the use of intrathecal fentanyl as multimodal analgesia became a popular technique for cesarean section, because of synergistic effect with local anaesthetic and intensify sensory block without increasing sympathetic block. This study aimed to assess postoperative analgesic effect of intrathecal fentanyl as an adjuvant to spinal anaesthesia in comparison with spinal anaesthesia with bupivacaine only among laboring mothers who undergone emergency cesarean delivery. Methods: A hospital based observational cohort study was conducted by recruited 100 patients scheduled for emergency cesarean section and grouped in to BS group, 12.5mg bupivacaine only (n =50) and BF group, 25mcg fentanyl with 10mg bupivacaine (n =50). Patient’s vital signs were taken intraoperativley. Postoperatively duration & consumption of analgesia, first analgesia request as well as severity of pain using 100mm VAS score were assessed over 12hrs. Normally distributed data analyzed using student t test and none parametric data was analyzed using Mann-Whitney U test with 95% CI and p- value less than 0.05 is considered as statistically significant. Results: Bupivacainefentanyl group (BF, n=50) compared with bupivacaine only group (BS, n=50), total duration of analgesia was longer in BF group (275.10 ± 42.43) than BS group (156.10 ± 34.45) in minutes, P = 0.001, analgesia request time in BF (301.00 ± 46.55) vs. (200.20 ± 44.19) in minute in BS group, P = 0.001 also longer. Not only this but also total amount of tramadol consumption 50(50) mg in BF vs. 100 (50) mg in BS, P = 0.001. VAS score also reduced at 2hrs, 3hrs, 4hr, 5hrs and 6hrs in BF group. None of group BS patients developed pruritus but 7(14%) in group BF developed mild pruritus, which did not need treatment. Shivering occurred 15(30%) patients in BF vs. 29(58%) in BS group with p- value of 0.005. Conclusion: Addition of intrathecal fentanyl as an adjuvant to bupivacaine for emergency cesarean section increased duration of analgesia, reduced postoperative analgesia consumption and request time without any maternal and fetal effect. We recommend the use of intrathecal fentanyl for emergency cesarean section in our set up.