The effects of sufentanil, fantanil and morphine in addition to spinal levobupivacaine in caesarean section.

ABSTRACTThe Effects Of Sufentanil, Fentanyl And Morphine İn Addition To SpinalLevobupivacaine İn Caesarean SectionThis prospective, randomized, double-blind study was conducted to compare thesensory and motor block characteristics and side effects of fentanyl, sufentanil andmorphine given intrathecally in addition to 0.5% plain levobupivacaine (15 mg) forspinal analgesia in parturients undergoing caesarean section.Following faculty ethic committee approval and written parturient consent, 135ASA I or II adult parturients undergoing Caesarean section were allocated to one of thethree groups according to the computer generated random table. Group I (n=40) received7,5 mg of 0.5% (1.5 ml) levobupivacaine + fentanyl (20 µcg) (0.5 ml), Group II (n=40)received 7,5 mg of 0.5% (1.5 ml) levobupivacaine + sufentanil (2 µcg) (0.5 ml), andGroup III (n=40) received 7,5 mg of 0.5% (1.5 ml) levobupivacaine + morphine (200µcg) (0.5 ml), in totally 2 ml intrathecally. Onset and duration of sensory and motorblock, maximal dermatomal level of sensory block, time to reach the maximaldermatomal level of sensory block and duration of spinal analgesia, supplement analgesicrequirement, haemodynamic variables and side effects were recorded at 1 minutesintervals for 10 minutes then at 10, 15, 20, 25 and 30 min after the injection, andsubsequently every 15 min until the block regressed to T10 for 120 minutes. Additionally,demographic data of mothers and neonatal Apgar scores, at 1 and 5 min, were recorded.Mann-Whitney U and Qui-square tests were used to evaluate the statistical analysis.Lower than p<0,05 values was accepted as significant.There were no significant differences between groups in patient characteristics orhaemodynamic variables. The onset time of sensory block was significantly longer ingroup III than in group I and II (p<0,01). Time to supplement analgesic requirement wassignificantly longer in group III than in group I and II (p<0,013).Time to 2 dermatomallevel regression, regression to T10, time to reach maximal sensory block height, time toBromage 3, time to resolve of motor block, the duration of spinal analgesia weresignificantly longer in group III than in group I and II (p<0,01). Itching was the mostseen side effect in groups. However, the incidence of nausea and vomiting wassignificantly higher in morphine group than in fentanyl and sufentanil groups (p<0,05).In patients undergoing caesarean section with spinal anaesthesia, the addition ofmorphine (200 µcg) intrathecally to 7,5 mg of spinal levobupivacaine (0.5%) prolongedthe onset of both sensory and motor blockade, the duration of spinal analgesia and time tosupplement analgesic requirement, delayed time to two dermatomal level regression,regression to T10, time to reach maximal sensory block height, time to Bromage 3 butprovided higher incidence of nausea and vomiting than intrathecal levobupivacaine(0.5%) plus fentanyl and intrathecal levobupivacaine (0.5%) plus sufentanilcombinations.Key words: Spinal anaesthesia, levobupivacaine, sufentanil, fentanyl, morphine, caesareansection.VII