A comparative study on spinal fentanyl and sufentanil plus 5% lidocaine at the onset of pain and analgesia after caesarean sections

The administration of either intrathecal or epidural opioid can provide deep neuroaxial anesthesia without significant changes in sensory or motor functions. This technique may reduce both mortality and morbidity, in comparison with systemic opioids. It seems, then, that using opioids (e. g. Fentanyl or Sufentanil) along with anesthetics (Lidocaine) in spinal anesthesia may also provide better pain control both during and after caesarean sections. This study was a prospective, randomized, double-blind and controlled trial on 86 pregnant women, ASA I-II, who were scheduled for elective caesarean section under the subarachnoid block in the year of 2008. The patients were divided into two groups (1 and 2) on the basis of a randomized digital table according to their taking sufentanil or fentanyl. In both groups, the local anesthetic used was hyperbaric lidocaine 5% (80 mg) with a total volume of 2. 2 ml. of the solution. Then, the onset of pain and the need for analgesia after the caesarean section were evaluated. Both groups received drugs intrathecally as follows: Group 1:20μg Fentanyl, 80 mg lidocaine %5, 0. 2 mg Epinephrine. Group 2:2 μg Sufentanil, 80 mg lidocaine %5, 0. 2 mg Epinephrine. In addition, Visual Analogous Scale (VAS: 0-10) was used to assess the intensity of pain and the patient’s sedation both in the recovery room and in the ward every one hour for 6 hours. The side effects and the need for drugs were recorded. As the findings of the study suggest, the onset of pain after cesarean section was more significant in the Sufentanil group than the Fentanyl group (P=0. 046). In this study, the Sufentanil group`s pain began about twenty minutes later than that of the Fentanyl group. Although the patients in the Sufentanil group appeared to need analgesic about twenty-six minutes later than those in the Fentanyl group, there was not any significant difference between these two groups of the study (P=0. 173). In terms of side effects, only more shivering was observed in the Sufentanil group than in the Fentanyl group (P=0. 003). As for Neonate ׳s APGAR and the other side effects, there weren’t any significant differences between the two groups, either. Fentanyl and Sufentanil plus intrathecal Lidocaine provided a good pain control for elective caesarean section; however, no significant difference was noted in terms of side effects. As a whole, Fentanyl and Sufentanil plus 5% Lidocaine can intrathecally induce sufficient analgesia after cesarean sections. More specifically, spinal anesthesia with lidocaine 5% and 2 µg of Sufentanil may bring about sufficient analgesia after the operation and is recommended for induced anesthesia in operations.