Ahmad Nizam, Ismail
(2011)
Combined spinal epidural analgesia in
labor: comparison of intrathecal 2mg
plain bupiv a caine versus heavy bupiv a caine
with fentanyl.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Spinal opioid analgesia utilizing analgesics has been one of the major developments during the past
decade in the management of acute and chronic pain. The relief of pain is due to the interaction of the
opioid injected epidurally or intrathecally with a specific opioid receptor in the spinal cord. The result is
zones of segmental analgesia without the loss of motor function or loss of other sensory modalities such
as touch sensation.
The use of opiates in the conjunction with the spinal or epidural local anaesthetic such as bupivacaine
afford prolonged post operative pain relief (Aboulish et al, 1988, Akerman et al, 1988). A possible
synergistic analgesic effect between the local anaesthetic and opioids may have important clinical
implications, however, this effect is difficult to evaluate in man (Akerman et al, 1988).
As there are only few studies on analgesic duration of plain bupivacaine, a double blind randomized
prospective study was conducted on 90 patients who had undergone parturient in labour in Hospital
Universiti Sains Malaysia, Kelantan. The aim of our study was to ascertain whether a smaller dose of
intrathecal bupivacaine can preserve the quality of analgesia while generating fewer adverse effects.
Ninety patients with no complicating obstetric and medical problem, whose age ranges from 18 and 42
years were selected randomly into two groups. Group I patients received 2 mg plain intrathecal
bupivacaine with 25mcg fentanyl and group 2 received 2 mg intrathecal heavy bupivacaine with 25 meg
fentanyl .The pain was assessed on the variables at time 0 (time at the start of IT injection) and at 5, 15,30
min. The result revealed that the use of 2 mg heavy bupivacaine with 25 meg fentanyl produce
adequate level of analgesia at TIO and no incidence of high sensory block. It was statistically
significant comparing both groups with a p value of 0.003. In terms of side effect, our study has
shown less incidence of side effect including nausea and/or vomiting as well as incidence of
pruritus is significantly reduced in the study population ( nausea and/or vomiting P value at
0.049 and pruritus p value = 0.026.
Actions (login required)
 |
View Item |
