2023, Number 3
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Rev Mex Anest 2023; 46 (3)
Intrathecal multimodal anesthesia in caesarean sections, changes that improve its efficacy and safety: clinical trial
Alba-Valverde RA, Aguilar-González CL, Moreno-Barrón ML
Language: Spanish
References: 23
Page: 179-183
PDF size: 301.41 Kb.
ABSTRACT
Introduction: the concentration and speed in the administration of intrathecal multimodal anesthesia with fentanyl in cesareans section improve anesthetic efficacy while maintaining good hemodynamic control.
Objective: to evaluate if some changes in intrathecal multimodal anesthesia improve its efficacy and safety in cesareans section.
Material and methods: clinical trial, controlled, randomized, double blind; in pregnant women scheduled for cesarean section, divided into 3 groups: group F6B2: fentanyl 65 μg + hyperbaric bupivacaine 2.5 mg+ morphine 100 μg+ dexmedetomidine 5 μg; group F6B3: fentanyl 60 μg + hyperbaric bupivacaine 3 mg + morphine 100 μg + dexmedetomidine 5 μg; and group F7B2: fentanyl 70 μg + hyperbaric bupivacaine 2 mg + morphine 100 μg + dexmedetomidine 5 μg. The anesthetic efficacy was evaluated prior to the incision, during the dissection of the abdominal wall, upon the admission to the abdominal cavity, in the review of paracolic slides and in the immediate postoperative period, as well as the vital signs.
Results: the F6B2 and F6B3 groups turned out to have greater anesthetic efficacy in the revision of paracolic slides (p = 0.02) and the F7B2 group had the highest safety with better hemodynamic control at 1 and 10 minutes (p = 0.03 and p = 0.03, respectively).
Conclusions: changes in the administration of intrathecal multimodal anesthesia with fentanyl improved anesthetic efficacy, but decreased safety over hemodynamyc control.
REFERENCES
De Alba-Valverde RA, Aguilar-González CL, Paque-Bautista C, González AP, Sosa-Bustamante GP. Eficacia y seguridad de la anestesia multimodal intratecal con fentanilo en cesárea: ensayo clínico. Rev Mex Anestesiol. 2023;46:1-61.
Von Cube B, Teschemacher H, Herz A, Hess R. Permeation of active morphine-like substances at their sites of antinociceptive action in the brain as a function of their lipid-solubility following intravenous and intraventricular application. Naunyn Schmiedebergs Arch Pharmakol 1970;265:455-473.
Mugabure B. Factores clave que afectan a la biodisponibilidad de los opioides sobre la médula espinal en el manejo del dolor agudo. Rev Soc Esp Dolor. 2019;26:359-367.
Bernards CM. Understanding the physiology and pharmacology of epidural and intrathecal opioids. Best Pract Res Clin Anaesthesiol. 2002;16:489-505.
Hindle A, MB ChB, BSc (Hons), DA, FRCA. Intrathecal opioids in the management of acute postoperative pain. Continuing Education in Anesthesia Critical Care and Pain. 2008;8:81-85.
Venegas A. Anestesia intravenosa. Editorial Panamericana, 2ª ed. 2008, pp. 256-258.
Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. 1991;72:275-281.
Marinho S, Frias P, Oliveira I, Melo BC, Rodrígues F, Paiva A. Cauda equina syndrome following combined spinalepidural anesthesia with levobupivacaine for cesarean section. Rev Esp Anestesiol Reanim (Engl Ed). 2021;68:484-486.
Salguiro C, Moreno M, Arthagnan C, Peleritti H, Rempel J. Bajas dosis de bupivacaína asociada a fentanilo en anestesia espinal. Técnicas de Anestesia Neuroaxial. 2007;65:401-408.
Bofill GP, Valenzuela LK, Carballea Y, et al. Anestesia subaracnoidea con dosis variables de bupivacaína con fentanilo en la resección transuretral de la próstata. Rev Méd Electrón. 2017;39:495-506.
Ben David B, Miller G, Gavriel R, Gurevitch A. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25:235-239.
Leo S, Sng BL, Lim Y, Sia AT. A randomized comparison of low dose of hyperbaric bupivacaine in combined spinalepidural anesthesia for cesarean delivery. Anesth Analg. 2009;109:1600-1605.
Turhanoglu S, Kaya S, Erdogan H. Is there and advantage in using low-dose intrathecal bupivacaine for cesarean section? J Anesth. 2009;23:353-357.
Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuroaxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013;110:915-925.
Liu L, Qian J, Shen B, Xiao F, Shen H. Intrathecal dexmedetomidine whit decrease the 95% effective dose of bupivacaine in spinal anesthesia for cesarean section: a prospective, double-blind, randomized study. Medicine (Baltimore). 2019;98:e14666.
Shah OM, Bhat KM. Comparison of the efficacy and safety of morphine and fentanyl as adjuvants to bupivacaine in providing operative anesthesia and postoperative analgesia in subumbilical surgeries using combined spinal epidural technique. Anesth Essays Res. 2017;11:913-920.
Weigl W, Bierylo A, Wielgus M, Krzemien-Wiczynska S, Kolacz M, Dabrowski MJ. Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section: a randomized controlled study. Medicine (Baltimore). 2017;96:e8892.
González-Navarro P. Opioides de corta duración en obstetricia. Rev Mex Anest. 2013;36:154-158.
Ortíz-Gómez JR, Palacio-Abizanda FJ, Fornet-Ruiz I. Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural. An Sist Sanit Navar. 2014;37:411-427.
Mercier FJ, Auge M, Hoffmann C, Fischer C, LeGouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol. 2013;79:62-73.
Braga Ade F, 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 Cir Bras. 2014;29:752-758.
Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anaesth. 2007;54:531-537.
Kaya S, Karaman H, Erdogan H, Akylmaz A, Turhanoglu S. Combined use low-dose bupivacaine, colloid preload and wrapping of the legs for preventing hypotension in spinal anesthesia for caesarean section. J Int Med Res. 2007;35:615-625.