The Used of Fentanyl as Adjunction Bupivacaine in Spinal Anaesthesia, is it Better?

Authors : Yudha Ferriansyah; Bakti Setiadi

Volume/Issue : Volume 7 - 2022, Issue 12 - December

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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


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