G. Dahlgren et al., INTRATHECAL SUFENTANIL, FENTANYL, OR PLACEBO ADDED TO BUPIVACAINE FORCESAREAN-SECTION, Anesthesia and analgesia, 85(6), 1997, pp. 1288-1293
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.