Abstract

ARAGON, M. C. et al. Perioperative analgesia in cesareans: effectiveness and safeness of intrathecal fentanyl. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.2, pp.30-35. ISSN 1134-8046.

Objectives: To assess perioperative analgesic effectiveness and safeness in elective cesareans of 50 µg of intrathecal fentanyl associated to hyperbaric bupivacaine, as well as its maternofetal effect and comfort. Material and method: Forty delivering women proposed for elective cesarean under subarachnoid anesthesia were randomly selected and divided in 2 groups. Group B received 12.5 mg of hyperbaric bupivacaine, and Group F received 12.5 mg of hyperbaric bupivacaine associated to 50 µg of fentanyl. All patients received 500 ml of SSF prior to the blockade and puncture was performed at L4-L5 (90%) and L3-L4 (10%) levels with a pencil-tip 25G needle. The following was assessed: biometric data, intraoperative hemodynamics, length of the motor blockade, time elapsed until the first VAS>0 and time elapsed until the administration of the first analgesic, APGAR of the newborn, side effects and comfort of the mother. Results: No significant differences were observed in biometrical data, volume of crystalloids administered or length of the surgical procedure. Patients in Group F showed extended and improved postoperative analgesia as compared to Group B, post-poning the need of the first analgesic more than 6 hours without any significant increases in the length of the motor blockade. No neonatal effects were found as assessed through the Apgar test. Side effects were mild and did not require treatment in any patient. Itching incidence was significantly greater in Group F (Group B =5% versus Group F =60%). There were no significant differences as regards other side effects, although the incidence of nausea was smaller in group B. The degree of comfort of the delivering women was high in both groups, but greater scores were obtained in Group F. Conclusion: The addition of fentanyl 50 µg to the local anesthetic, hyperbaric bupivacaine for subarachnoid anesthesia in cesareans is an effective technique that increases intensity and length of the sensitive blockade, extending the post-operative analgesia for more than 6 hours without affecting the recovery of the motor blockade, without any fetal effect and with a low incidence of side effects, except for mild itching.

Keywords : Obstetric anesthesia; Subarachnoid anesthesia; Fentanyl; Bupivacaine; Itching.

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