Efficacy of intrathecal fentanyl along with bupivacaine and bupivacaine alone in lower segment caesarean section

Background: Spinal anesthesia is oldest and all over the world till date one of the most frequently employed methods of regional anesthesia. The addition of opiates like the lipophilic opioid Fentanyl to local anaesthetics produces many of its clinical effects very early after intrathecal administration. Aim: The study was designed to compare the efficacy of intrathecal Fentanyl along with Bupivacaine and Bupivacaine alone and their effect on prolonging the duration of postoperative analgesia in lower segment caesarean section without any adverse effects. Materials and methods: Fifty ASA physical status I and II patients scheduled for elective lower segment caesarean section surgery were studied. Patients were randomly divided into two groups i.e., group FB and group B consisting of 25 patients each. Patients in group FB were given 8.5 mg of 0.5% hyperbaric Bupivacaine plus 25 µg of Fentanyl (0.5 cc) and group B received 8.5 mg of 0.5% hyperbaric Bupivacaine plus 0.5 cc of normal saline to adjust the final volume to 2.2 cc. Results: It was found that addition of 25 µg of Fentanyl to 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine had no effect on the onset of analgesia to pin prick, maximum level of analgesia and time to achieve maximum level. Fentanyl did not prolong the Bupivacaine sensory block but there was a significant prolongation of postoperative analgesia with addition of Fentanyl. Fentanyl 25 µg did not enhance the onset and duration of sensory block produced by 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine. Fentanyl however, prolonged post-operative analgesia and lowered the incidence of shivering. The incidence of pruritus was high, but it was usually mild in Fentanyl 25 µg along with 8.5 mg of 0.5% hyperbaric Bupivacaine. Conclusions: Intrathecal Fentanyl with Bupivacaine is very much safer than other opioids like morphine which has more postoperative complications like intense, intermittent respiratory depression.