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Comparison of sequential and mixture injections of opioids and hyperbaric bupivacaine for subarachnoid block for lower segment caesarean section: a randomised controlled study.
- Source :
-
Irish journal of medical science [Ir J Med Sci] 2024 Aug; Vol. 193 (4), pp. 1977-1983. Date of Electronic Publication: 2024 Apr 11. - Publication Year :
- 2024
-
Abstract
- Introduction: Opioids are commonly added to local anaesthetic for subarachnoid block for caesarean section due to their synergistic effects. The physiochemical characteristics of opioids suggest premixing with hyperbaric bupivacaine may limit their distribution within the CSF. We studied the effect of a separate injection with a combination of bupivacaine, morphine and fentanyl on block characteristics, haemodynamic changes, postoperative pain and patient satisfaction.<br />Method: Following ethical approval and informed consent, a prospective double-blinded randomised controlled trial was performed in a university hospital. A total of 126 patients undergoing caesarean section were randomised to two groups. In group M, the premixed group, patients received 12 mg of hyperbaric bupivacaine, 20 mcg of fentanyl and 100 mcg of morphine injected as a single mixture. In group S, the separate injection group, patients received the same drugs in separate injections. Measurements included haemodynamics, block distribution, intra- and postoperative pain, as well as patient satisfaction.<br />Results: Patients in both groups had similar block height, time to maximum sensory block, time to block regression and motor block. However, haemodynamics were different between the groups. The proportion of systolic hypotension episodes was greater in group S [159/1320 (12.05%)] than group M [113/1452 (7.78%)], with P = 0.0002. Moreover, a greater amount of ephedrine was administered in group S than group M, with values 12.09 (8.1) and 9.09 (8.5) mg respectively (P = 0.001). Additionally, postoperative pain, as measured by the Visual Analogue Scale (VAS), was greater in group M, with a VAS of 4.6 (1.7), vs. group S, which recorded a VAS of 3.8 (2.0) (P = 0.017).<br />Conclusion: Sequential injection of intrathecal opioids and hyperbaric bupivacaine resulted in greater early haemodynamic instability and slightly better postoperative analgesia without any difference in block height or patient satisfaction.<br />Clinical Trial Registration: NCT04403724.<br /> (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)
- Subjects :
- Humans
Female
Adult
Double-Blind Method
Pregnancy
Subarachnoid Space
Patient Satisfaction statistics & numerical data
Prospective Studies
Anesthesia, Spinal methods
Nerve Block methods
Hemodynamics drug effects
Bupivacaine administration & dosage
Bupivacaine therapeutic use
Cesarean Section
Analgesics, Opioid administration & dosage
Analgesics, Opioid therapeutic use
Anesthetics, Local administration & dosage
Anesthetics, Local therapeutic use
Morphine administration & dosage
Morphine therapeutic use
Pain, Postoperative drug therapy
Pain, Postoperative prevention & control
Fentanyl administration & dosage
Fentanyl therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1863-4362
- Volume :
- 193
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Irish journal of medical science
- Publication Type :
- Academic Journal
- Accession number :
- 38602618
- Full Text :
- https://doi.org/10.1007/s11845-024-03682-w