The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Comparison of pain with bupivacaine and bupivacaine-sufentanil combination in women undergoing cesarean section with spinal anesthesia: A double-blind randomized clinical trial

Document Type : Original Article

Authors
Hasan Zabetian 1
Mohammad Rahmanian 2
Nahid Tadayon 2
Navid Kalani 3
1 Associate Professor, Department of Anesthesiology, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
2 General Physician, Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3 Instructor, Department of Anesthesiology, Non-communicable Diseases Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
10.22038/ijogi.2022.21195
Abstract
Introduction: Today, spinal anesthesia is the method of choice for most cesarean sections. Postoperative pain control has always been one of the main concerns of anesthesiologists. Therefore, this study was performed aimed to compare the amount of pain with the use of bupivacaine and bupivacaine-sufentanil combination in women undergoing cesarean section with spinal anesthesia.
Methods: This double-blind randomized clinical trial study was performed in 2021 on 30 patients undergoing elective cesarean section referred to Motahari Hospital in Jahrom. Patients were randomly divided into two groups of bupivacaine and bupivacaine-sufentanil. Patients' pain was assessed at 2, 6, 12 and 24 hours after surgery. Data were analyzed by SPSS software (version 21) and T-test, Mann-Whitney and Chi-square tests. P<0.05 was considered statistically significant.
Results: The results of Mann-Whitney test showed that the mean pain in 2 hours after surgery was higher in the bupivacaine group than the bupivacaine + sufentanil group (P = 0.03). At other times, the mean pain was not significantly different between the bupivacaine + sufentanil and the bupivacaine groups (P >0.05). The most common postoperative complication in bupivacaine + sufentanil group was pruritus (53.3%).
Conclusion: The use of spinal sufentanil with intrathecal bupivacaine in cesarean section reduces the pain in the first hours after cesarean section.
Keywords
Bupivacaine
Cesarean section
Spinal Anesthesia
Sufentanil
  1. Bryson GL, MacNeil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery. Canadian Journal of Anesthesia 2007; 54(7):531-7.
  2. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. The Journal of the American Society of Anesthesiologists 1979; 50(2):149-51.
  3. Nasr IA, Elokda SA. Safety and efficacy of intrathecal adjuvants for cesarean section: bupivacaine, sufentanil, or dexmedetomidine. Ain-Shams Journal of Anaesthesiology 2015; 8(3):388.
  4. Van de Velde M, Van Schoubroeck D, Jani J, Teunkens A, Missant C, Deprest J. Combined spinal-epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesthesia & Analgesia 2006; 103(1):187-90.
  5. Burns SM, Cowan CM, Wilkes RG. Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice. Anaesthesia 2001; 56(8):777-98.
  6. Vercauteren MP, Coppejans HC, Hoffmann VL, Saldien V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarean section. Anesthesia & Analgesia 1998; 86(5):989-93.
  7. Birnbach DJ, Meininger D, Byhahn C, Kessler P, Nordmeyer J, Alparslan Y, et al. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesthesia & Analgesia 2003; 96(3):852-8.
  8. Sridhar G. Post caesarean delivery pain management. International Journal of Obstetric Anesthesia 2007; 16(2):186.
  9. Malekshoar M, Vatankhah M, Rasekh Jahromi A, Ghasemloo H, Mogharab F, Ghaedi M, et al. Shivering control in women under spinal anesthesia: A narrative review on the role of drugs. Iran J Obstet Gynecol Infertil 2021; 24(7):61-69.
  10. Ghasemloo H, Sadeghi SE, Jarineshin H, Rastgarian A, Taheri L, Rasekh Jahromi A, et al. Control of nausea and vomiting in women undergoing cesarean section with spinal anesthesia: A narrative review study on the role of drugs. Iran J Obstet Gynecol Infertil 2021; 24(7):98-107.
  11. Jarineshin H, Sadeghi SE, Malekshoar M, Sanie Jahromi MS, Rahmanian F, Hatami N, et al. Non-pharmacological methods of controlling nausea and vomiting during pregnancy in Iran: A narrative review study. Iran J Obstet Gynecol Infertil 2022; 24(12):110-23.
  12. Masoumi Z, Keramat A, Hajiaghaee R. Systematic review on effect of herbal medicine on pain after perineal episiotomy and cesarean cutting. Journal of Medicinal Plants 2011; 10(40):1-16.
  13. Adibi P, Vatankhah M, Razavi BM, Fendereski F, Malekshoar M. Intravenous Pethidine versus Diclofenac Suppository in Shivering after Cesarean Section under Spinal Anesthesia. J Med Chem Sci 2022; 5(7):1142-9.
  14. Bang YS, Chung KH, Lee JH, Hong SK, Choi SH, Lee JY, et al. Comparison of clinical effects according to the dosage of sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean journal of anesthesiology 2012; 63(4):321-6.
  15. Braga AD, Braga FS, Hirata ES, Pereira RI, Frias JA, Antunes IF. Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study. Acta Cirurgica Brasileira 2014; 29:752-8.
  16. Dourado AD, Lins Filho RL, Fernandes RA, Gondim MC, Nogueira EV. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial. Revista Brasileira de Anestesiologia 2016; 66:622-7.
  17. Hu J, Zhang C, Yan J, Wang R, Wang Y, Xu M. Sufentanil and bupivacaine combination versus bupivacaine alone for spinal anesthesia during cesarean delivery: a meta-analysis of randomized trials. PloS one 2016; 11(3):e0152605.
  18. Yahya M, Sriramamurthy K, Farhat S, Kumari S. Effect of addiction of fentanyl to low dose bupivacaine in cesarean under spinal anesthesia. Eur J Pharm Med Res 2017; 4(2):568-72.
  19. Borjian Boroojeny S, Hojjat SM. Comparison of Intensity and Duration of Analgesia as Well as Complications Addition of Intrathecal Fentanyl or Sufentanil to Bupivacaine 0.5% Hyperbaric for Spinal Anesthesia in Patients Undergoing Elective Cesarean Section. Journal of North Khorasan University of Medical Sciences 2020; 12(1):98-102.
  20. Demiraran Y, Ozdemir I, Kocaman B, Yucel O. Intrathecal sufentanil (1.5 µg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy. Journal of anesthesia 2006; 20(4):274-8.
  21. Alimian M, Mohseni M, Faiz SH, Rajabi A. The effect of different doses of intrathecal hyperbaric bupivacaine plus sufentanil in spinal anesthesia for cesarean sections. Anesthesiology and Pain Medicine 2017; 7(6).
  22. Lee JH, Chung KH, Lee JY, Chun DH, Yang HJ, Ko TK, et al. Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean journal of anesthesiology 2011; 60(2):103-8.
  23. Vatankhah M, Sadeghi SE, Zarenezhad M, Rasekh Jahromi A, Kalani N, Hatami N, et al. Low doses of propofol and midazolam on maternal hemodynamic symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section: A double-blind randomized clinical trial study. Iran J Obstet Gynecol Infertil 2021; 24(2):41-9.
  24. Farzi F, Mirmansouri A, Nabi BN, Roushan ZA, Sani MN, Azad SM, et al. Comparing the effect of adding fentanyl, sufentanil, and placebo with intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing cesarean section. Anesthesiology and pain medicine 2017; 7(5).
  25. Khoshraftar E, Moazami F, Ashrafi B. Effect of Single Shot Intrathecal Sufentanil on Delivery Time and Analgesia in Nuliparae. Avicenna Journal of Clinical Medicine 2008; 15(1):22-6.
  26. Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiology clinics 2017; 35(1):107-24.
  27. Zabetian H, Rahmanian M, Damshenas MH, Rastgarian A, Nabipour M, Hatami N, et al. The effect of adding pethidine to bupivacaine 0.5 and ropivacaine 0.5 on pain intensity in women undergoing elective cesarean section with spinal anesthesia: A double-blind randomized clinical trial study. Iran J Obstet Gynecol Infertil 2022; 25(2):1-12.
  28. Lim Y, Jha S, Sia AT, Rawal N. Morphine for post-caesarean section analgesia: intrathecal, epidural or intravenous?. Singapore medical journal 2005; 46(8):392.
  29. Shakeri A, Taghizadeh S, Razavi M. Comparison the Effect of Paracetamol and Ketorolac on Pain Relief after Cesarean Section. Journal of Pharmaceutical Research International. 2019; 31(6):6.
  30. Adibi P, Vatankhah M, Malekshoar M, Razavi BM, Zarei T. Post Cesarean Section Analgesic Effects of Intravenous Pethidine and Diclofenac Suppository after Spinal Anesthesia: A Randomized Clinical Trial. J Med Chem Sci 2022; 5(7):1150-5.
  31. Ferrarezi WP, Braga AD, Ferreira VB, Mendes SQ, Brandão MJ, Braga FS, et al. Spinal anesthesia for elective cesarean section. Bupivacaine associated with different doses of fentanyl: randomized clinical trial. Brazilian Journal of Anesthesiology 2021; 71:642-8.
  32. Karaman S, Kocabas S, Uyar M, Hayzaran S, Firat V. The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. European journal of anaesthesiology 2006; 23(4):285-91.
  33. Moosavi Tekyeh SM, Tabari M, Jahanian V. Investigation the effects and side effects of different dosage of bupivacaine in combination with sufentanil for spinal anesthesia in cesarian section. Iran J Obstet Gynecol Infertil 2013; 16(66):1-9.
  34. Vyas N, Sahu DK, Parampill R. Comparative study of intrathecal sufentanil bupivacaine versus intrathecal bupivacaine in patients undergoing elective cesarean section. Journal of Anaesthesiology, Clinical Pharmacology 2010; 26(4):488-92.
  35. Lord Lasemi S, Delavar P, Hadavand S. Prevalence of pruritus following Intrathecal fentanyl and sufentanil after spinal anesthesia in cesarean section. Iran J Obstet Gynecol Infertil 2021; 24(3):33-41.
  36. Alipour M, Tabari M, Sharifian Attar A, Asghari S. Nausea and vomiting after spinal anesthesia with two drugs combinations of bupivacaine-fentanyl and bupivacaine-sufentanil during cesarean section. Iran J Obstet Gynecol Infertil 2021; 24(2):1-7.
  37. Kumar K, Singh SI. Neuraxial opioid-induced pruritus: an update. Journal of anaesthesiology, clinical pharmacology 2013; 29(3):303-7.
  38. Bujedo BM. Current update in the management of post-operative neuraxial opioid-induced pruritus. Journal of Clinical Research in Anesthesiology 2018; 1(1):1-10.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 25, Issue 8
October 2022
Pages 8-18