ANESTHETIC QUALITY DURING CESAREAN-SECTION FOLLOWING SUBARACHNOID OR EPIDURAL ADMINISTRATION OF BUPIVACAINE WITH OR WITHOUT FENTANYL

Background: It is often assumed that subarachnoid administration of lo cal anesthetics produces a more profound blockade than epidural anesth esia. Furthermore, the addition of fentanyl has been reported to incre ase preferentially intraoperative analgesia. In the present study we s et out to study these two issues in a randomized and controlled study with respect to perceived pain and discomfort during surgery and posto perative pain. Methods: In the present study 100 parturients subjected to elective cesarean section, 34 nullipara and 66 multipara, received one out of four combinations of the local anesthetic bupivacaine and the opioid fentanyl; group A - bupivacaine 12.5 mg + 10 mu g fentanyl subarachnoidally, group B - bupivacaine 12.5 mg + saline subarachnoida lly, group C - bupivacaine 100 mg + 100 mu g fentanyl epidurally, grou p D - bupivacaine 100 mg;saline epidurally; N = 25 in each group. Pain intensity and discomfort during surgery was assessed with a visual an alogue scale (VAS). Postoperative pain intensity and need for analgesi cs postoperatively, ketobemidone, was registered for 24 h following su rgery. Results: Intraoperative pain intensity and discomfort did not d iffer significantly between parturients in any of the four groups. Pos toperative pain was significantly more intense in parturients receivin g local anesthetics subarachnoidally as compared to the epidural group s during the first 6-h period. This difference was also reflected in a significantly increased consumption of analgesics during this period. No significant differences between the groups were observed with rega rd to hemodynamics (blood pressure), respiration (oxygen saturation) o r other effects such as nausea or itching. All neonates had normal Apg ar and neonatal adaptive capacity scores (NAGS). Conclusion: We conclu de that subarachnoidal (12.5 mg) and epidural (100 mg) injections with bupivacaine both produced adequate anesthetic quality in women underg oing elective cesarean section. The addition of fentanyl (10 mu g suba rachnoidally or 100 mu g epidurally) did not significantly improve the quality of these already profound blockades. (C) Acta Anaesthesiologi ca Scandinavica 41 (1997).