Effects of Varying Doses of Plain Bupivacaine with Fentanyl in Patients Undergoing Cesarean Section: Haemodinamics and Neonatal Outcome
Aim. The purpose of this study was to evaluate a three different regimes of spinal anaesthesia for caesarean delivery as well the incidence and severity of maternal hypotension and its influence over neonatal outcome.
Material and Methods. Sixty (60) term healthy (ASA I) parturients scheduled for elective or non-elective caesarean delivery without fetal distress under spinal anaesthesia were randomly divided in three groups: group SA F10 (n = 20) received plain bupivacaine 12 mg plus 10 μg fentanyl, group SA F20 (n = 20) received 11 mg plus 20 μg fentanyl and SA LD group (low dose, n = 20) received 8 mg bupivacaine plus 20 μg fentanil. Ephedrine 5-10 mg i.v. bolus was given when systolic blood pressure (SBP) was < 95 mmHg. Maternal blood pressures, efedrin dosage, sensory level of anaesthesia, Apgar scores and neonatal umbilical cord blood acid-base (Ua) status were evaluated.
Results. Spinal block provided surgical anaesthesia in all patients. Peak sensory level was higher in the greatest bupivacaine group (4.9 ± 1.33, 5.0 ± 1.21 vs. 5.4 ± 1.55). Parturient who received 12 mg bupivacaine (SA F10 group) develop significantly decrease of SBP - 97.9 ± 8.9 mmHg (23.8%), after spinal blockade compared with low dose group SA LD - 125.0 ± 12.9, (6.0%, p<0.05) and 115.1 mmHg (17.5%) in the SA F20 group. The total amount of ephedrine to treat hypotension was significantly lower in the low dose group (SA LD) compared with two other group (1.75 ± 1.0 mg vs. 13.75 ± 6.5 mg (SA F10) and 11.75 ± 6.2 (SA F20, p<0.5). Neonatal Ua pH was significantly lower with SA F10 group than low dose spinal group-SA LD (7.22 ± 0.07 vs. 7.27 ± 0.04, p < 0.05; 7.23 ± 0.04 SA F20 group).
Conclusion. spinal anaesthesia for caesarean delivery with a low dose bupivacaine of 8 mg in conjunction with 20 μg fentanyl leads to less hypotension and ephedrine requirements with better neonatal outcome when compared with 12 and 11 mg bupivacaine - fentanyl spinal anaesthesia.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Marija Tolevska, Filip Naumovski, Marija Srceva, Aleksandra Panovska Petrusheva, Rexhep Selmani and Atanas Sivevski
Background: Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair.
Methods: After the hospital ethics committee approval, 60 (ASA I–II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of morphine dose over 24-hours.
Results: There were statistically significant differences in VAS scores between the groups I and II at all postoperative time points - 2hr, 4 hr, 6 hr, 12 hr and 24 hr. (P < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in the group II (mean = 3.73 ± 1. 41) than the group I (mean = 8.76 ± 2.41). This difference was statistically significant (p = 0.00076).
Conclusion: The ultrasound guided rectus sheath block used for umbilical hernia repair could reduce postoperative pain scores and the amount of morphine consumption in 24 hours postoperative period.
Andrijan Kartalov, Nikola Jankulovski, Biljana Kuzmanovska, Milka Zdravkovska, Mirjana Shosholcheva, Tatjana Spirovska, Aleksandra Panovska Petrusheva, Marija Tolevska, Marija Srceva, Vesna Durnev, Gjorgji Jota, Redzep Selmani and Atanas Sivevski
Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.
Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.
Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).
Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).