Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial

• Published in: Brazilian journal of anesthesiology (Elsevier) Vol. 71; no. 6; pp. 642 - 648
• Main Authors: Ferrarezi, Wesla Packer Pfeifer, Braga, Angélica de Fátima de Assunção, Ferreira, Valdir Batista, Mendes, Sara Quinta, Brandão, Maria José Nascimento, Braga, Franklin Sarmento da Silva, Carvalho, Vanessa Henriques
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01-11-2021; Elsevier
• Subjects: Anesthesia, Obstetrical - adverse effects; Anesthesia, Spinal - adverse effects; Anesthetics, Local - adverse effects; Bupivacaine; Bupivacaine - adverse effects; Cesarean; Cesarean Section; Clinical Research; Double-Blind Method; Female; Fentanyl; Fentanyl - adverse effects; Humans; Infant, Newborn; Pregnancy; Prospective Studies; Spinal anesthesia; Fentanyl; Bupivacaine; Cesarean; Spinal anesthesia
• ISSN: 0104-0014; 0104-0014; 2352-2291
• DOI: 10.1016/j.bjane.2021.03.030

Assess patients submitted to elective cesarean section under spinal anesthesia, and the efficacy of different doses of fentanyl associated with bupivacaine.
The study included 124 pregnant women randomly distributed into 4 groups (n = 31) according to different doses of fentanyl (15 μg, 10 μg, 7.5 μg), Groups I, II, and III, respectively, and control group IV, associated with 0.5% hyperbaric bupivacaine (10 mg). An epidural catheter was inserted in case epidural top-up was required. We assessed the anesthetic blockage characteristics, negative maternal and neonatal outcomes, and maternal side effects. Statistical analysis was performed using Kruskal-Wallis, Fisher’s exact and chi-square tests. The level of significance was 5% (p < 0.05).
The quality of analgesia, time for the first complaint of pain and motor block recovery time were significantly better for groups that received fentanyl in comparison to controls (p < 0.001). None of the groups had negative maternal-fetal outcomes. Nausea was significantly more frequent in patients in Groups II (10 µg) and III (7.5 µg) when compared to Groups I (15 µg) and IV (no fentanyl). Vomiting was more frequent in Group III than in Group I (p = 0.006). The incidence of pruritus was significantly higher in the groups receiving fentanyl (p = 0.012).
Among the solutions studied, the spinal anesthesia technique using 15 µg of fentanyl associated with 10 mg of hyperbaric bupivacaine provided satisfactory analgesia and very low incidence of adverse effects for patients submitted to cesarean section.
UTN U1111-1199-0285.
RBR-5XWT6T.