Comparison of Spinal Block Characteristics Between Height and Weight Based Dosage to Addition of Fentanyl in 0.5% Hyperbaric Intrathecal Bupivacaine for Elective Cesarean Section

Abstract

Introduction:  Association of low dose of bupivacaine with fentanyl can reduce hemodynamic adverse events and improve the quality of analgesia reducing intraoperative incidence. The study evaluates the effect of fentanyl as adjuvant intrathecally to dose calculated by Harten’s chart to determine hemodynamic effects and quality of analgesia undergoing cesarean section.

Method: Hundred term parturients were enrolled in each group using randomised sampling technique, undergoing elective cesarean section under spinal anesthesia were enrolled in this cross-sectional study carried out in Dhulikhel Hospital, KUSMS. Group N received only total dose of 0.5% hyperbaric Bupivacaine calculated by Harten’s chart and Group F received total dose of 0.5% hyperbaric Bupivacaine calculated by Harten’s chart with addition of 10 mcg Fentanyl intrathecally as adjuvant. Hemodynamic parameters, onset of sensory block at T6 level with motor blockade, intraoperative analgesic requirement with adverse effect were studied and compared.

Result:  Hypotensive episodes were more in Group F (26.4%) but lesser adverse effect like nausea, vomiting and bradycardia (1.9%) than in Group N (p<0.001). Intraoperative analgesic requirement was significantly higher with Group N (68.1%) with p<0.001. The time of achieving sensory block to T6 level and motor blockade to Grade III was early in Group F than in Group N p=0.05.

Conclusion: Addition of intrathecal fentanyl (low dose as 10 mcg) results early onset of sensory blockade, gives synergistic effect providing better intraoperative and postoperative analgesia and less complication like nausea, vomiting and shivering with good fetal outcome.