Authors :
Yudha Ferriansyah; Bakti Setiadi
Volume/Issue :
Volume 7 - 2022, Issue 12 - December
Google Scholar :
https://bit.ly/3IIfn9N
Scribd :
https://bit.ly/3VoqquX
DOI :
https://doi.org/10.5281/zenodo.7480801
Abstract :
Regional anaesthesia is a major factor in patient safety
during Caesarean delivery. Resurgence of spinal anaesthesia
as a popular technique was possible due to the development
of small-bore needles with pencil-point tips and has become
the preferred method of anaesthesia for elective and for many
emergency Caesarean deliveries.1 A survey of Society for
Obstetric Anesthesia and Perinatology members found that
spinal anesthesia is most commonly used for elective
cesarean delivery (85% respondents), with 90% of these
respondents preferring hyperbaric 0.75% bupivacaine.
Further, 79% of responders added fentanyl, 77% added
morphine, and 54% added both fentanyl and morphine to the
intrathecal bupivacaine for spinal anesthesia. 2
Bupivacaine is the most commonly used local
anesthetics in spinal anesthesia, in The Anaesthesia textbooks
recommend bupivacaine in a dose of between 12 and 15 mg.
3 A number of studies have sought an optimal dose of
bupivacaine, but produced dissimilar findings with doses
ranging from 5 to 20 mg. The use of a lower dose aims to
decrease maternal side-effects (hypotension, intraoperative
nausea/ vomiting), reduce the time to discharge from the postanaesthesia care unit, and improve maternal satisfaction.1
Intrathecal opioid and local anesthetic combinations are
popular for analgesia because of rapid, effective pain relief,
but the duration of analgesia is limited. 4 Fentanyl has been
used as an adjunct to bupivacaine for spinal anaesthesia for
elective caesarean section as it has been shown both to
improve the quality of block and reduce the need for
intraoperative supplementation of opioids. 5.
Fentanyl, a lipophilic opioid, has a fast onset and is 10–
20 times more potent when administered intrathecally compared to the IV route. Eventhough, a “ceiling effect” has been
observed in intrathecal doses >0.25 μg/kg, implying that
higher doses of intrathecal fentanyl do not improve intraoperative analgesia and may increase side effects. 6
Moreover, spinal route for fentanyl and sufentanil have not
been approved by the United States Food and Drug
Administration (FDA). In FDA’s labels, only intravenous or
intramuscular routes are predicted for fentanyl citrate
ampoules and intravenous or epidural routes for sufentanil. 7
This systematic literature review aimed to compare
bupivacaine single dose with bupivacaine fentanyl
combination in spinal anaesthesia
Regional anaesthesia is a major factor in patient safety
during Caesarean delivery. Resurgence of spinal anaesthesia
as a popular technique was possible due to the development
of small-bore needles with pencil-point tips and has become
the preferred method of anaesthesia for elective and for many
emergency Caesarean deliveries.1 A survey of Society for
Obstetric Anesthesia and Perinatology members found that
spinal anesthesia is most commonly used for elective
cesarean delivery (85% respondents), with 90% of these
respondents preferring hyperbaric 0.75% bupivacaine.
Further, 79% of responders added fentanyl, 77% added
morphine, and 54% added both fentanyl and morphine to the
intrathecal bupivacaine for spinal anesthesia. 2
Bupivacaine is the most commonly used local
anesthetics in spinal anesthesia, in The Anaesthesia textbooks
recommend bupivacaine in a dose of between 12 and 15 mg.
3 A number of studies have sought an optimal dose of
bupivacaine, but produced dissimilar findings with doses
ranging from 5 to 20 mg. The use of a lower dose aims to
decrease maternal side-effects (hypotension, intraoperative
nausea/ vomiting), reduce the time to discharge from the postanaesthesia care unit, and improve maternal satisfaction.1
Intrathecal opioid and local anesthetic combinations are
popular for analgesia because of rapid, effective pain relief,
but the duration of analgesia is limited. 4 Fentanyl has been
used as an adjunct to bupivacaine for spinal anaesthesia for
elective caesarean section as it has been shown both to
improve the quality of block and reduce the need for
intraoperative supplementation of opioids. 5.
Fentanyl, a lipophilic opioid, has a fast onset and is 10–
20 times more potent when administered intrathecally compared to the IV route. Eventhough, a “ceiling effect” has been
observed in intrathecal doses >0.25 μg/kg, implying that
higher doses of intrathecal fentanyl do not improve intraoperative analgesia and may increase side effects. 6
Moreover, spinal route for fentanyl and sufentanil have not
been approved by the United States Food and Drug
Administration (FDA). In FDA’s labels, only intravenous or
intramuscular routes are predicted for fentanyl citrate
ampoules and intravenous or epidural routes for sufentanil. 7
This systematic literature review aimed to compare
bupivacaine single dose with bupivacaine fentanyl
combination in spinal anaesthesia
