INTRATHECAL SUFENTANIL, FENTANYL, OR PLACEBO ADDED TO BUPIVACAINE FORCESAREAN-SECTION

We compared the effects of intrathecal sufentanil 2.5 and 5 mu g, fent anyl 10 mu g, and placebo when administered together with hyperbaric b upivacaine 0.5% 12.5 mg for cesarean section. The study was performed in a randomized, double-blind fashion in 80 (20 per group) healthy, fu ll-term parturients presenting for elective cesarean section. Postoper ative pain was assessed using the visual analog scale (VAS). Duration of complete analgesia was defined as the time from the intrathecal inj ection to VAS score >0. Duration of effective analgesia was defined as the time to VAS score greater than or equal to 4. No patient experien ced intraoperative pain. Complete analgesia was prolonged in all group s receiving opioids. Effective analgesia was prolonged and the 0- to 6 -h intravenous opioid requirements were lower in the groups receiving sufentanil compared with those receiving fentanyl and placebo. The nee d for intraoperative antiemetic medication was greater in the placebo group. Pruritus was a frequent and dose-related side effect in the gro ups receiving sufentanil. There were no differences in umbilical cord blood gases or neonatal Apgar scores and neurological and adaptive cap acity scores among the groups. In conclusion, the addition of sufentan il or fentanyl improved the quality of subarachnoid block compared wit h placebo. The duration of action was longer for sufentanil than fenta nyl. Implications: Small doses of fentanyl or sufentanil (synthetic op ioids) added to bupivacaine (local anesthetic) for spinal anesthesia f or cesarean section reduce the need for intraoperative antiemetic medi cation and increase the duration of analgesia in the early postoperati ve period compared with placebo.