COMPARISON OF HEMODYNAMIC STABILITY IN EMERGENCY LSCS OF INTRATHECAL FENTANYL AND BUPIVACAINE VS BUPIVACAINE ALONE AT TERTIARY CARE CENTRE

doi:N/A

International Journal of Medical and Pharmaceutical Research

2024, Volume-5, Special Issue 6

Original Research Article

COMPARISON OF HEMODYNAMIC STABILITY IN EMERGENCY LSCS OF INTRATHECAL FENTANYL AND BUPIVACAINE VS BUPIVACAINE ALONE AT TERTIARY CARE CENTRE

Dr Pravin Sherkhane, Dr Abhimanyu Tarkase, Dr Aparna Kulkarni, Dr Rajeshri Dhawale

Published

Dec. 29, 2024

Abstract

Background: Spinal anesthesia is the preferred technique for lower segment cesarean section (LSCS) due to its rapid onset, reliable sensory and motor blockade, and minimal neonatal drug exposure. Hyperbaric bupivacaine is the most commonly used anesthetic; however, higher doses may lead to hemodynamic instability and prolonged motor blockade. Intrathecal fentanyl, an opioid adjuvant, has been proposed to enhance sensory blockade and prolong analgesia with minimal impact on hemodynamics.

Objective: To compare the hemodynamic stability, sensory and motor blockade characteristics, and postoperative analgesia between two spinal anesthesia regimens in emergency LSCS: (1) standard-dose bupivacaine (10 mg) and (2) low-dose bupivacaine (7.5 mg) with fentanyl (25 mcg).

Methods: A prospective, randomized clinical trial was conducted at a tertiary care center with 100 full-term pregnant women undergoing emergency LSCS. Patients were randomly assigned to Group A (10 mg of 0.5% hyperbaric bupivacaine) or Group B (7.5 mg of 0.5% hyperbaric bupivacaine with 25 mcg fentanyl). Hemodynamic parameters, sensory and motor blockade onset, duration of analgesia, and maternal side effects were assessed.

Results: Group B demonstrated a significantly prolonged duration of sensory blockade (p < 0.05) and improved postoperative analgesia compared to Group A. Hemodynamic stability, as measured by mean arterial pressure and heart rate fluctuations, was better maintained in Group B. The incidence of hypotension and bradycardia was lower in Group B, while opioid-related side effects such as pruritus were slightly more common but clinically manageable. Neonatal outcomes were comparable between both groups.

Conclusion: The addition of intrathecal fentanyl to a lower dose of bupivacaine in emergency LSCS provides superior sensory blockade, prolonged analgesia, and better hemodynamic stability compared to bupivacaine alone. This combination may be a preferable option for spinal anesthesia in cesarean deliveries, ensuring maternal comfort with minimal side effects.

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