Effects of Spinal Anesthesia with Low-Dose of Lidocaine plus Fentanyl on Maternal Hemodynamic State in Severe Pre-eclamptic Patients Undergoing Cesarean Section

Document Type : Original Article

Authors

Abstract

Introduction: The hypotension following spinal anesthesia remains common place in cesarean
delivery. Sympathetic blockade effects are more intense in preeclamptic parturients and these
patients need more ephedrine after spinal block. Intrathecal opioids are synergistic with local
anesthetics and intensify sensory block without increasing sympathetic block. The aim of this
study was to evaluate maternal hemodynamic stability, following spinal anesthesia with lowdose
of lidocaine plus fentanyl severe pre-eclamptic parturients undergoing in cesarean
section.
Materials and Methods: This clinical trial study was performed from 2005 to 2006 on
patients at Al-Zahra Hospital of Tabriz University of Medical Sciences. A total of 60 patients
with severe preeclampsia divided into two groups of case and control randomly. Thirty
patients received 50mg lidocaine with 10µg fentanyl (study group), and in the other 30 patients
100mg lidocaine (control group) was used during spinal anesthesia. Heart rate and blood
pressure were recorded at regular intervals. Pain, discomfort, nausea, and vomiting during
surgery were observed. Neonatal Apgar score was assessed at 1 and 5 min after delivery. All
data were recorded in a questionnaire and analyzed by descriptive statistics, Fisher, Ki Square
and T-Tests.
Results: Patients of the study group had a less frequent incidence of clinically significant
hypotension (20% vs 63.33% of patients respectively; p<0.0001). The magnitude of the
decrease in blood pressure was significantly larger in the control patients than the study group
(34.6±10.3 percent vs 23.5±8.4 percent respectively; p<0.0001). Ephedrine requirements due
to hypotension were more in the control group than in the study group (4.0±5.15 mg vs
1.33±2.60 mg respectively; p=0.015). The incidence in heart rate changes, higher than 30%
was also similar between the groups. However, the incidence in heart rate was larger
magnitude in the control group (p=0.19). Pain and discomfort during surgery were experienced
more frequently in the control group (83.33%) than in study group (16.66%). Neonatal 1-and
5-min Apgar scores were also similar in two groups (p=0.75, p=0.22 respectively).
Conclusion: Intrathecal low-dose of lidocaine with fentanyl provides a good surgical
anesthesia with hemodynamic stability, without neonatal compromise in severe preeclamptic
patients undergoing cesarean section

Keywords


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