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

References

1. Miller RD. Miller's Anesthesia. 6th ed, Phyladelphia: Elsevier Churchil livingstone; 2005. 2333.
2. Chestnut DH. Obstetric Anesthesia. 2th ed. Newyork: Mosby; 1999. 905-80.
3. Okafor UR, Okezie O. Maternal and fetal outcome of anesthesia for caesarean delivery in
preeclampsia in Enugu, Nigeria: a retrospective observational study. Int J Obstet Anesth 2005;
14(2):108-30.
4. AYA AGM, Mangin R, Vialles N , Ferror J-M, Robert C, Ripart J, et al. Patients with severe
preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery
than healthy parturients: A prospective cohort comparison. Anesth Analg 2003; 97(3):867-72.
5. Mandal NG, Surapaneni S. Regional anesthesia in preeclampsia: advantages and disadvantages.
Drugs 2004; 64(3):223-36.
6. Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anesthesia
for cesarean section in preeclamptic patients. Int J Obstet Anesth 2003;12(1):23-7.
7. Sharwood-Smith G, Clark V, Watson E. Regional anesthesia for cesarean section in severe
preeclampsia: Spinal anesthesia is the preferred choice. Int J Obstet Anesth 1999; 8(2): 85-9.
8. Karinen J, Rasanen J , Alahuhta S, Jouppila R, Jouppila P. Maternal and uteroplacental
hemodynamic state in preeclamptic patients during spinal anesthesia for cesarean section. Br J
Anesth 1996; 76(5):616-20.
9. Shifman Em, Filipprovich GV. Safety of subarachnoid anesthesia during cesarean in pregnant
women with preeclampsia. Anesthesiol Reanimatol 2003; sep-oct (5): 38-41.
10. Ahmed SM, Khan RM, Bano S, AJmani P, Kumar A. Is spinal anesthesia safe in preeclamptic
toxemia patients? J Indian Med Assoc 1999; 97(5):165-80.
11. Santos AC, Birnbach DJ. Spinal anesthesia in the parturient with severe preeclampsia: Time for
Reconsideration. Anesth Analg 2003; 97:621-3.
12. Clark VA, Sharwood-Smith GH, Stewart AVG. Ephedrine requirements are reduced during spinal
anesthesia for cesarean section in preeclampsia. Int J Obstet Anesth 2005; 14(1):9-13.
13.Jain K, Grover K, Mahajan R, Batra YK. Effect of varying doses of fentanyl with low dose spinal
bupivacaine for cesarean delivery in patients with pregnancy-induced hypertension. Int J Obstet
Anesth 2004; 13(4):215-20.
14. Ramanathan J, Vaddadi AK, Arheart KL. Combined spinal and epidural anesthesia with low doses
of intrathecal bupivacaine in women with severe preeclampsia: a preliminary report. Reg Anesth
pain Med 2001; 26(1):46-51.
15. Choi DH, Ahn HJ Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean
delivery. Reg Anesth Pain Med 2000; 25(3):240-5.
16. Helbo-Hansen HS, Ang U, Lindholm P, Klitgaard NA. Neonatal effects of adding epidural fentanyl
0.5% bupivacaine for cesarean section. Int J Ostet Anesth 1993; 2(1):27-33.
17. Obara M, Sawamura S, Satoh Y, Chinzei M, Sekiyama H, Tamaj H, et al. The effect of intrathecal
fentanyl added to hyperbaric bupivacaine for cesarean section. Masui 2003; 52(4): 378-82.
18. Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil,
fentanyl or placebo added to bupivacaine for cesarean section. Anesth Analg 1997; 85(6):1288-93.
19. Ben-David B, Miller G, Gavriel R, Gurevitch A. Low dose bupivacaine – fentanyl spinal anesthesia
for cesarean delivery. Reg Anesth Pain Med 2005; 25(3):235-9.
20. Lim Y, Loo CC, Goh E. Ultra low dose combined spinal and epidural anesthesia for cesarean
section. Int J Obstet Anesth 2004; 13(3):198-9

Files

Share

How to cite

Statistics