COMPARATIVE STUDY OF FENTANYL AND MORPHINE IN ADDITION TO HYPERBARIC OR ISOBARIC BUPIVACAINE IN COMBINED SPINAL ANESTHESIA FOR CESAREAN SECTION
M.AKSOY
1, A.SARAÇOĞLU
2, KT.SARAÇOĞLU
2, Z.ETİ
2
BÖLGE EĞİTİM ARAŞTIRMA HASTANESİ ANESTEZİYOLOJİ VE REANİMASYON AD ERZURUM 1
MARMARA ÜNİVERSİESİ TIP FAKÜLTESİ ANESTEZİYOLOJİ VE REANİMASYON AD İSTANBUL 2
The aim of our study was to compare the effects of isobaric and hyperbaric bupivacaine combined with morphine or fentanyl in patients undergoing cesarean section. We assessed quality and spread of analgesia and anesthesia, postoperative analgesic requirement and side effects.
100 patients with American Society of Anesthesiologists physical status (ASA) I-II, age 18 to 40 years were randomized to four groups. The intrathecal solutions were: isobaric bupivacaine + morphine (Group A), isobaric bupivacaine + fentanyl (Group B), heavy bupivacaine + morphine (Group C) and heavy bupivacaine + fentanyl (Group D). Mean arterial pressure, heart rate, oxygen saturation, ephedrine consumption, analgesic requirement time and additional analgesic needs were recorded.
The first minute value of mean arterial pressure was the lowest one in all groups. Heart rate decreased significantly in Group A at 10th minute but not in the other groups. The decreasing of Visuel Analogue Scale (VAS) pain scores has began in the groups after the postoperative 4th hour (p< 0,05) and VAS values of Group B at 8th hour was significantly higher than the other groups. The first analgesic requirement time in the postoperative period were longer in patients who had intrathecal morphine than those who had fentanyl. The duration of analgesia with isobaric bupivacaine and morphine was the longest one.
As a summary we concluded that, intrathecal morphine provides a long duration of postoperative analgesia but the duration gets longer when it is combined with plain bupivacaine instead of heavy bupivacaine.
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