بررسي مقايسه اي تاثير افزودن فنتانيل اينتراتكال در روزهاي 12/5 ميكروگرم به ليدوكايين هيپرباريك در بيدردي عمل سزارين

The Effect of Addition of Intrathecal Fentanyl to Hyperbaric Lidocaine for Cesarean Section Analgesia

Combining intrathecal local anesthetics with opioids has become a favorable practice for pain relief. The rationale is that these agents work at two distinct sites to eliminate pain via a combined and synergistic mechanism. In this study we evaluated the effect of two doses of intrathecal fentanyl combined with hyperbaric lidocaine on the quality and duration of analgesia and incidence of spinal anesthesia complications. Frothy five patients were enrolled in this randomized , double -- blind , placebo controlled , clinical trial study , 15 in each group. They received either intrathecal 75 mg Iidocaine plus 0.5 cc normal saline (control group) , 75 mg lidocaine plus 12.5 µg fentanyl (12.5 µg group) or 75 mg lidocaine plus 25 µg fentanyl (25 µg group). The onset time of anesthesia , quality of analgesia : intra operatively , in recovery and post-op period on the basis of visual analogue scale (VAS) , duration of analgesia and spinal anesthesia complications , mean analgesic need in post-op period was recorded by a blinded observer. The data was analyzed by statiscal tests (kruskal-Wallis , ANOVA , x^2) with EPI6 and SPSS software. There were no demographic differences among groups. The onset time of anesthesia was shorter in two groups of fentanyl than placebo group (P=0.01). Paine score (VAS) intra-op and in recovery was lower in 25 µg fentanyl group , (P=0.05) (P=0.04). VAS in post-op period was not different in three groups. The incidence of systolic hypotension in 25 µg fentanyl group was lower than two other groups(P=0.022). Duration of analgesia and mean analgesic need in post-op period and Incidence of other complications of spinal anesthesia were not different in three groups. Addition of intrathecal fentanyl 25 µg to hyperbaric Iidocaine in spinal anesthesia produces more rapid onset of anesthesia and improves quality of analgesia and decreases incidences of spinal hypotension .