Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-28T00:28:21.893Z Has data issue: false hasContentIssue false
  • English
  • Français

The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for Caesarean section

Published online by Cambridge University Press:  27 January 2006

S. Karaman ,
S. Kocabas ,
M. Uyar ,
S. Hayzaran  and
V. Firat
S. Karaman
Affiliation:
Ege University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
S. Kocabas
Affiliation:
Ege University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
M. Uyar
Affiliation:
Ege University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
S. Hayzaran
Affiliation:
Ege University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
V. Firat
Affiliation:
Ege University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Izmir, Turkey
Get access

Extract

Summary

Background and objective: The quality of spinal anaesthesia, often used for Caesarean section, can be improved by adding an opioid to the local anaesthetic. This study compared the quality of anaesthesia, postoperative analgesia, and adverse effects on mother and neonate when either sufentanil 5 μg or morphine 0.2 mg was added to intrathecal hyperbaric bupivacaine for Caesarean section. Methods: This prospective, randomized and double-blind study encompassed 54 females undergoing Caesarean section. Spinal anaesthesia was obtained with 2 mL of 0.5% bupivacaine supplemented with either 0.2 mg morphine or 5 μg sufentanil. Characteristics of spinal block, intraoperative analgesia, maternal and neonatal side-effects and the time to first request for analgesics were assessed. Results: There were no differences in the onset time of sensory block, time to sensory block to T10, time to highest sensory block, highest sensory block level, time to regression of sensory block to T10 level and time to resolution of motor blockade. Perioperative haemodynamic parameters, neonatal Apgar scores, neurological and adaptive capacity scores, umbilical blood gas values, sedation scores, nausea–vomiting and pruritus incidences were similar in both groups. The time to the first request for an analgesic was significantly longer (19.5 ± 4.7 h vs. 6.3 ± 5.2 h) in patients given morphine (P < 0.05). Conclusions: The addition of 5 μg sufentanil or 0.2 mg morphine to hyperbaric bupivacaine for Caesarean section both provided safe and effective anaesthesia. Morphine increased the duration of postoperative analgesia compared with sufentanil without increasing maternal or neonatal side-effects.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, spinalANAESTHETICS, LOCAL, bupivacaineANALGESICS, OPIOIDS, morphine, sufentanilOBSTETRIC SURGICAL PROCEDURES, Caesarean section, delivery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 285 - 291
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dickenson AH. Spinal cord pharmacology of pain. Br J Anaesth 1995; 75: 193–200.Google Scholar
Katz J, Kavanagh BP, Sandler AN et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology 1992; 77: 439–446.Google Scholar
Liu S, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001; 94: 888–906.Google Scholar
Dahlgren G, Hultstrand C, Jakobsson J et al. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 1997; 85: 1288–1293.Google Scholar
Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology 2000; 92: 739–753.Google Scholar
Nelson K, Rauch T, Terebuh V et al. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology 2002; 96: 1070–1073.Google Scholar
Culebras X, Gaggero G, Zatloukal J, Kern C, Marti R-A. Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects. Anesth Analg 2000; 91: 601–605.Google Scholar
Hunt CO, Naulty JS, Bader AM et al. Perioperative analgesia with subarachnoid fentanyl bupivacaine for cesarean delivery. Anesthesiology 1989; 71: 535–540.Google Scholar
Uchiyama A, Ueyama H, Nakano S, Nishimura M, Tashiro C. Low dose intrathecal morphine and pain relief following caesarean section. Int J Obstet Anesth 1994; 3: 87–91.Google Scholar
Yamaguchi H, Watanabe S, Fukuda T, Takahashi H, Motokawa K, Ishizawa Y. Minimal effective dose of intrathecal morphine for relief following transabdominal hysterectomy. Anesth Analg 1989; 68: 537–540.Google Scholar
Abouleish E, Rawal N, Fallon K, Hernandez D. Combined intrathecal morphine and bupivacaine for cesarean section. Anesth Analg 1988; 67: 370–374.Google Scholar
Dahl JB, Jeppesen IS, Jorgessen H et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioid in patients undergoing cesarean section with spinal anesthesia. Anesthesiology 1999; 91: 1919–1927.Google Scholar
Braga AFA, Braga FSS, Potério B et al. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003; 20: 631–635.Google Scholar
Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.Google Scholar
Palmer CM, Cork RC, Hays R et al. The dose-response relation of fentanyl for labor analgesia. Anesthesiology 1998; 88: 355–361.Google Scholar
Riley ET, Ratner EF, Cohen SE. Intrathecal sufentanil for labor analgesia: do sensory changes predict better analgesia and greater hypotension? Anesth Analg 1997; 84: 346–351.Google Scholar
Courtney MA, Bader AM, Hartwell B, Hauch M, Grenan MJDatta S. Perioperative analgesia with subarachnoid sufentanil administration. Reg Anesth 1992; 17: 274–278.Google Scholar
Abboud TK, Dror A, Mosaad P et al. Minidose intrathecal morphine for relief of post-Cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide. Anesth Analg 1998; 67: 137–143.Google Scholar
Stoelting RK. Pharmacology and Physiology in Anesthetic Practise, 3rd edn. Philadelphia: Lippincott Company, 1999: 77–181.
Weber EWG, Slappendel R, Gielen MJM, Dirksen R. Intrathecal addition of morphine to bupivacaine is not the cause of postoperative nausea and vomiting. Reg Anesth Pain Med 1998; 23: 81–86.Google Scholar
Alhashemi JA, Crosby ET, Grodecki W et al. Treatment of intrathecal morphine-induced pruritus following caesarean section. Can J Anaesth 1997; 44: 1060–1065.Google Scholar
Ferouz F, Norris MC, Arkoosh VA, Leighton BL, Boxer LM, Corba RJ. Baricity, needle direction, and intrathecalsufentanil labor analgesia. Anesthesiology 1997; 6: 592–598.Google Scholar
Cohen SE, Subak LL, Brose WG, Halpern J. Analgesia after cesarean delivery: patient evaluations and costs of five opioid techniques. Reg Anesth 1991; 16: 141–149.Google Scholar
Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg 1992; 74: 653–657.Google Scholar
Abouleish E, Rawal N, Rashad N. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases. Reg Anesth 1991; 16: 137–140.Google Scholar
Swart M, Sewell J, Thomas D. Intrathecal morphine for caesarean section: an assessment of pain relief, satisfaction and side-effects. Anaesthesia 1997; 52: 364–381.Google Scholar
Standl TG, Horn E, Luckmann M, Burmeister M, Wilhelm S, Schulte EJ. Subarachnoid sufentanil for early postoperative pain management in orthopedic patients: a placebo-controlled, double-blind study using spinal microcatheters. Anesthesiology 2001; 94: 230–238.Google Scholar