COMPARISON OF 2 FENTANYL DOSES TO IMPROVE EPIDURAL-ANESTHESIA WITH 0.5-PERCENT BUPIVACAINE FOR CESAREAN-SECTION

Ninety women undergoing elective caesarean section under epidural anae sthesia were double blindly randomised into three groups to receive ei ther 2 ml of saline or 50 or 100 mug of fentanyl in 2 ml volume added to 0.5% bupivacaine. Both doses of fentanyl intensified the epidural a naesthesia and reduced patient discomfort during the operation. In bot h fentanyl groups the epidural blockade more often reached the 5th tho racic segment (P=0.0258), the patients had significantly less pain (P= 0.0256), needed less intravenous diazepam medication during the operat ion (P=0.0005) and the operating conditions were better when compared to the saline group (P=0.0416). There was no difference between the gr oups in the condition of the neonates as assessed by the Apgar score a nd cord blood pH. The postoperative time until treatment for pain was requested by the patients was more than 1 h longer in the fentanyl gro ups, but there was no difference in the total amount of postoperative analgesics needed during the first 24 h when compared to the saline gr oup. Mild pruritus not requiring treatment was more common in fentanyl groups than in the saline group (P= 0.0187). The results suggest that 50 mug of fentanyl added to 0.5% bupivacaine increases patient comfor t and improves the quality of epidural anaesthesia for caesarean secti on, and that adding 100 mug does not give further advantage.