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THE CLINICAL TRIAL OF THREE DIFFERENT DOSES OF 0.5% BUPIVICAINE-FENTANYL IN SPINAL ANAESTHESIA FOR CAESAREAN DELIVERY
Dr. Natiq D. Shaalan*
Background: The combination of local anesthetics (0.5%bupivacaine) and opioid (fentanyl) in spinal anesthesia for Caesarean delivery has been practiced worldwide as it is safe, effective and has less maternal complications. This study aims to examine the effictiveness of 3 different doses of mixed spinal 0.5% bupivacaine with fentanyl and their subsequent maternal effects. Patients and Methods: After the consent was obtained from the patients who were included in our study, the prospective clinical trial case control study was conducted with the approval of the scientific committee of Iraqi consult. This study was conducted at the Department of Anesthesiology & Intensive Care, in obstetrics and gynecology hospital in Erbil from September to October 2015. Around 90 candidates of normotensive women with ASA I and II underwent elective Caesarean delivery under spinal anesthesia were randomly allocated into three groups of 30; group A received 10 mg (2ml) of 0.5% bupivacaine + 25 mcg fentanyl, group B received 12.5 mg (2.5ml) of 0.5% bupivacaine +25 mcg fentanyl, group C received 15 mg (3ml) of 0.5% bupivacaine +25 mcg fentanyl. In addition to the standard monitoring of vital signs, spo2 and ECG, monitoring of the anesthetic effects (onset of action, level of sensory block and muscle power (motor block)) were performed at 3 minutes interval after induction and preoperatively. Any complications that could occur during operation like nausea and vomiting were observed as well. Results: A total sample of 90 pregnant women underwent elective Caesarean delivery were selected in this study, with mean± S.D age of 27.36±6.126 years, and mean ±S. D weight of 72.69±10.24 kg. 60%, 73.3% and 80% for group A, group B and group C, respectively. Bolus dose of ephedrine was used for these cases. The heart rates of the patients among the study groups displayed significant difference between the study groups as the p-value was highly significant (p<0.005). Apparently, there was no significant difference in different doses of anesthetic drugs among the study groups regarding their onset of action, since the anesthetic agent of group C was the fastest to work by only 3.3 minutes while group A was slow to act with average of 4.4 minutes. However, the relationship between study groups and muscle power (motor block level) showed significant difference. The level of T10 dermatomal anesthesia reached in 99% of cases at 9th min after anesthetic induction. Conclusions: The combination of 0.5% bupivacaine and fentanyl in spinal anesthesia for Caesarean delivery was highly effective with excellent level anesthesia , however in addition to its hemodynamic side effect of given doses, it would give unnecessary sensory blockade level that would change blood pressure and pulse rate.[Full Text Article]