A prospective randomised double blind study of the comparison of two opioids- fentanyl and buprenorphine – as adjuvant to spinal bupivacaine in caesarean sections
Background: Opioids are first introduced as additives to spinal anaesthesia in 1979, with intrathecal morphine as forerunner. Neuraxial opioids when added to local anaesthetics prolong the duration of sensory block, improve quality of block and no unwanted sympathetic blockade leading to hypotension. This prospective randomized double blind study was undertaken to evaluate the duration of analgesia, sensory and motor blocking properties and side effects of two opioids – Fentanyl and Buprenorphine, when used as adjuvant to spinal Bupivacaine in caesarean section.
Methods: Sixty patients between the age group 18-35 years belonging to ASA I and II posted for elective LSCS were randomly divided into two groups. Each group consisting of 30 patients , received either 1.8 ml 0.5% Bupivacaine with 25 mcg Fentanyl (group F) or 1.8 ml 0.5% Bupivacaine with 75 mcg buprenorphine (Group B). The onset, maximum level and duration of sensory and motor blockade and hemodynamic parameters were monitored.
Results: Maximum height of sensory block was achieved faster in fentanyl group (i.e. 4.09±1.12 minutes compared to 4.56±1.21 minutes in buprenorphine group). Duration of analgesia was significantly prolonged in buprenorphine group. It was 317±54 minutes and 214±35 minutes respectively for buprenorphine and fentanyl groups.
Conclusions: The study thus concluded that although fentanyl produce faster sensory block, duration of analgesia is longer with buprenorphine, and both the drugs do not cause significant side effects.
Michael J Cousins Neural blockade in clinical anaesthesia and pain medicine. 4th edition. Philadelphia: Lippinjcott Williams and Wikins; 2009.
Collin VJ. Principles of Anaesthesiology. 3rd Edition. Philadelphia: Lea and Febiger; 1993.
Miller RD. Miller’s anaesthesia. 7th Edition. Philadelphia: Elsevier Churchill Livingstone; 2009: 2.
Stoeling RK. Intrathecal morphine- an under used combination for postoperative pain management. Anaesth Analg. 1989;68:707-9.
Lanz E, Suke G, Theiss D, Glocke MH. Epidural Buprenorphine a double blind study of postoperative analgesia and side effects. Anaesth analg. 1984;63:593-8.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain; Visual Analogue Scale for pain. Arthritis Care Res. 2011;63:240-52.
Chestnut DH. Obstetric Anaesthesia, Principles and practice. Philadelphia: Mosby; 2004: 534-6.
Stoelting RK. Pharmacology and physiology in anaesthetic practice. 4th edition. Philadelphia: Lippincott Williams and Wilkins; 2009.
Abouleish E, Rawl N, Show J, Lorenz T, Rashad MN. Intrathecal Morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients. Anaesthesiol. 1991:74:711-6.
Capogna G, Celleno D. Spinal Buprenorphine for postoperative analgesia after caesarean section. Acta Anaesthesiol Scand. 1989;33:236-8.
Wang JK, Nauss LA, Thomas JK. Pain Relief by intrathecally applied morphine in man. Anaesthesiol. 1979:50:149-51.
Belzarana SD. Clinical effects if intrathecally administered Fentanyl in patients undergoing caesarean section. Anaesth analg. 1992;74:653-7.
David BB, Solomon E. Intrathecal Fentanyl with small dose dilute Bupivacaine;better anaesthesia without prolonging recovery. Anaesth Analg. 1997;85:560-5.
Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S. Intrathecal Fentanyl with byperbaric Bupivacaine improves analgesia during caesarean delivery and early post op period. Indian J Anaesth. 2002;46(6):469-72.
Lane S, Evans P, Arjeen Z, Misra U. Effect of Fentanyl and diamorphine as adjuvant to spinal anaesthesia in caesarean section. Anaesthesia. 2005;60(5):453-7.
Khan FA, Hamdani GA. Comparison of intrathecal Fentanyl and Buprenorphine in Urological Surgery JPMA. 2006;56:6.
Dixit S. PostOperative analgesia after caesarean sections: an experience with intrathecal bupivacaine. Indian J Anaesth. 2007;51(6);515-8.
Sheikh S, Kiran M. Intrathecal buprenorphine for postoperative analgesia: A prospective double blind randomized study. J Anaesth Clin Pharmacol. 2010;26(1):35-8.
Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al .Perioperative analgesia with subarachnoid fentanyl bupivacaine for caesarean delivery. Anaesthesiol. 1989;71;535-40.
Shendi D, Cooper GM. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia. 1998;53(7):706-10.