Comparison of Intrathecal Bupivacaine Fentanyl Combination with Bupivacaine alone for Cesarean Delivery

Intrathecal Fentanyl when used along with bupivacaine has been shown to improve analgesia during cesarean delivery and in early postoperative period without untoward effects. It has also been suggested that the combination of these two drugs decreases the occurrence of perioperative nausea during cesarean delivery. We hypothesized that this combination could be used to improve the quality of spinal anaesthesia while incurring less frequent episodes of perioperative nausea.

200 women scheduled for cesarean delivery were divided into 2 groups of patients who received a spinal injection of either 2.5ml of 0.5% hyperbaric bupivacaine with 0.25 ml of normal saline or 2.5 ml of 0.5% hyperbaric bupivacaine with 0.25 ml (12.5μg) of fentanyl. Sensory blockade, degree of motor blockade, sedation score, intra and post operative nausea and vomiting were recorded. Neonatal Apgar score was recorded at 1 and 5 minutes and overall quality of anaesthesia was assessed.

Spinal block provided surgical anaesthesia in all patients. Time to peak sensory block was shorter in bupivacaine + fentanyl group (6.55 minutes v 8.47 minutes) compared to bupivacaine only group. A higher level of sensory block (about 2 sensory dermatomes) was achieved in bupivacaine + fentanyl group compared to bupivacaine only group. Mean duration of pain free period was significantly higher in bupivacaine + fentanyl group compared bupivacaine only group.

Adding fentanyl to bupivacaine in spinal anaesthesia results in marked prolongation of duration of pain free period with significant decrease in nausea and vomiting as a complication.