[Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial]

Sufentanil for Spinal Analgesia during Cesarean Section Delivery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To investigate the effect of sufentanil for spinal analgesia during cesarean section.

METHOD

Eligible papers were systematically retrieved from PubMed, Embase, Ovid, and ScienceDirect. Two researchers independently extracted primary and secondary endpoints to compute relative risk and mean difference by using the random-effects model or the fixed-effects model, as appropriate. Publication bias was quantified and assessed using funnel plot and Egger's test.

RESULT

A total of 8 publications with 503 pregnant women were included in this study for meta-analysis. Subarachnoid administration of sufentanil did not significantly reduce the onset time of sensory block and motor block. Nonetheless, subarachnoid administration of sufentanil significantly increased the incidence of postoperative skin pruritus (RR = 5.25, 95%CI: 1.90, 14.49, P < 0.001).

CONCLUSION

Subarachnoid administration of sufentanil has no significant difference in the combined effect value of shortening the onset time of sensory block and motor block, prolonging the onset time of local anesthesia and the incidence of some adverse reactions (such as postoperative nausea, vomiting, hypotension, and tremors). However, the incidence of skin pruritus was significantly increased, and the difference was statistically significant. Because of this, the drug still needs to be used with caution in combination with the actual situation in clinical use.

Addition of low-dose sufentanil to ropivacaine for reducing shivering and visceral traction pain during cesarean section

Objective

To investigate the efficacy of low-dose sufentanil for preventing shivering and visceral traction pain during cesarean section under spinal anesthesia.

Methods

This was a prospective, randomized, controlled study. A total of 112 full-term parturients who underwent elective caesarean delivery were randomly divided into two groups. Group R received 0.75% isobaric ropivacaine intrathecally and group RS received 0.75% isobaric ropivacaine plus 5 µg sufentanil intrathecally.

Results

There were no significant differences in the maximum sensory block time, motor block time, duration of the surgery, and heart rate, mean arterial pressure, and blood oxygen saturation before and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the surgery between the two groups. Shivering was significantly more common in group R (n = 30) than in group RS (n = 8). The incidence of visceral traction pain in group R (46.43%) was significantly higher than that in group RS (14.29%). There was no significant difference in the newborns’ Apgar scores between the groups.

Conclusion

Adding low-dose sufentanil to ropivacaine can significantly reduce the incidence of shivering and visceral traction pain after spinal anesthesia.

Cross-sectional study on hearing loss and auditory reaction time before and after spinal anesthesia with marcaine 0.5% in patients undergoing elective surgery

BACKGROUND

Hearing loss is a rarely reported complication of spinal anesthesia. The purpose of this study is to assess the effects of 0.5% Maracine (bupivacaine) on hearing threshold and auditory reaction time before and after spinal anesthesia among patients undergoing elective surgery.

MATERIALS AND METHODS

This is a descriptive cross-sectional study performed on 60 patients undergoing elective surgery with ASA Class II and II anesthesia (0.5% bupivacaine) at Khorramabad Nursing Home. After obtaining consent from the patients, audiometry and tympanometry tests were performed using AZ80 and Madsen otoflex tympanometer and related findings including the presence or absence of hearing loss at various frequencies, before and after the surgery, were noted in a form for each patients along with their demographic data. SPSS 21 was used for statistical analysis and the data were analyzed using descriptive statistics and chi-square inferential tests.

RESULTS

At low frequencies of 250 and 500 Hz, no significant difference in pre- and postoperative hearing threshold in the right ear (P > 0.05) was seen, but at frequencies above 500 Hz, the hearing threshold was significantly decreased after surgery, (P < 0.05). In the left ear at 250, 1000, 3000, and 8000 Hz, there was no significant difference (P > 0.05) between pre- and postoperative hearing threshold. The results of this study showed that the preoperative hearing threshold for men and women did not differ and the auditory threshold and auditory response time after surgery did not differ between the two sexes (P > 0.05). Similarly, the difference was not correlated with the age and the levels of anesthesia (P > 0.05). The results also showed that changes in mean arterial blood pressure (MAP) and heart rate above 30% of baseline were also not correlated with hearing loss (P > 0.05).

CONCLUSIONS

The results showed that at certain frequencies, hearing loss was observed in both ears after spinal anesthesia with 5% Marcaine, but this hearing loss was not related to age, sex, and spinal anesthesia level. The results also showed that changes in mean arterial blood pressure (MAP) and heart rate above 30% of baseline did not correlate with hearing loss.

The Effect of Different Doses of Intrathecal Hyperbaric Bupivacaine Plus Sufentanil in Spinal Anesthesia for Cesarean Sections

Background

Decreasing side effects and improving the quality of block in caesarean sections by appropriate dosage of local anesthetics and adjuvants could play an important role in the safe management of cesarean section. The present study aimed at comparing the effects of 3 different doses of intrathecal hyperbaric bupivacaine injected with a fixed dose of sufentanil in cesarean sections.

Methods

In a double- blind randomized clinical trial, 105 candidates of elective cesarean section were randomly assigned into 3 groups of 8, 9, and 10 mg of intrathecal bupivacaine plus sufentanil 2.5 µg. The maximum level of sensory block, the intensity of motor block, and vital signs were measured at regular intervals. The incidence of hypotension and bradycardia were also recorded.

Results

No significant difference was found between the maximum level of sensory block and the intensity of motor block in 3 groups. The incidences of hypotension and bradycardia as well as administration of atropine and ephedrine were comparable among the 3 groups (P > 0.05).

Conclusions

According to similar effects of different doses of bupivacaine, administration of lower doses of bupivacaine (8mg) is more reasonable for spinal anesthesia for cesarean section.

Pharmacological advances in the multimodal management of perioperative analgesia

The concept of multimodal analgesia is currently widespread in our clinical practice. The aim of multimodal analgesia is to reduce the side effects derived from the drugs or techniques used for the control of pain together with greater effectiveness (combination of multiple mechanisms of action) with the maximum efficiency, that is, to combine different pharmacodynamics (synergistic or additive effects) and pharmacokinetics, in the context of a predictable acute pain model, thus allowing a prior strategy such as the model of acute postoperative pain. Pain is a complex physiological phenomenon. Postoperative pain involves multiple pathways including nociceptive, inflammatory, and neuropathic sources. In the transmission of pain therefore, different molecules participate, which means that there are multiple pharmacological targets on which to act, and therefore a wide range of drugs to be used following the physiology of pain.