TO STUDY THE EFFICACY (DIFFERENTIAL BLOCK) OF INTRA- THECAL FENTANYL IN PROLONGING THE POST -OPERATIVE ANALGESIA WHEN ADDED TO HYPERBARIC BUPIVACAINE IN CAESAREAN SECTION

Dr Tejavath Padma, Dr Sowjanya, Dr Albeena, Dr Raju B

Abstract


BACKGROUND:

Spinal anesthesia is commonly employed for caesarean delivery. However intra-thecal bupivacaine alone may be insufficient to provide complete analgesia despite  the  high sensory block. Patient had  visceral pain  even  after  intra-thecal  administration  of  15 mg  of             bupivacaine.Further more        such      large  doses              of             intra-thecal  bupivacaine   were associated with severe hypotension and  delayed  recovery  of  motor  block.Therefore smaller    doses    of      bupivacaine    supplemented    by    intra-thecal Opioids   have     been recommended for spinal anesthesia in parturients undergoing caesarean section  delivery. Aim and objectives : To provide best intra-opertive and post-operative analgesia.

To clinically evaluate the efficacy (differential block) and side effects  of  intra-thecal fentanyl in prolonging the post -operative  analgesia  when  added  to  hyperbaric  bupivacaine in caesarean section.

Methods: After obtaining institutional ethical and scientific committee approval, we conducted the study in 60 patients, who were in ASA grade 1 and 2, aged between 19Y -55 Y posted for emergency and elective LSCS from August 2018 to August 2019. Who were divided into 2 groups 1& II , and both the groups received spinal using 26 G spinal needle at the level of L3-L4. Following which both the groups were monitored for onset ,duration

and quality of neuraxial block in both the groups. In post operative period Severity of the  pain was measured by visual analouge pain scale score (1-10).

RESULTS: Time for two segment  regression,  time  for  sensory  regression  to  L1 and  time for complete sensory recovery was significantly prolonged in bupivacaine  with  fentanyl combination when compared to bupivacaine alone.

CONCLUSION: Intrathecal fentanyl with Bupivacaine provide early onset, prolonged anesthesia and analgesia than Bupivacaine alone with acceptable side effects.


Keywords


spinal anesthesia, Intra-thecal fentanyl, caesarean section.

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