ADRENALINE, FENTANYL OR ADRENALINE AND FENTANYL AS ADJUNCTS TO BUPIVACAINE FOR EXTRADURAL ANAESTHESIA IN ELECTIVE CAESAREAN SECTION

We have compared the effects of extradural fentanyl and fentanylplus adrenaline with adrenaline alone as adjuncts to extraduralbupivacaine in patients undergoing elective Caesarean section.Forty-five patients were allocated randomly to receive 0.45%bupivacaine 20 ml with adrenaline 4.5 µg ml^–1, fentanyl4.5 µg ml^–1 or adrenaline plus fentanyl (4.5 µgml^–1 of each) as supplements. The main outcome measureswere time to bilateral analgesia of T6 or higher, need for intraoperativeanalgesic supplements, observer rating of intraoperative analgesiaand patient assessment of analgesia using a 10-cm visual analoguescale. The time to onset of analgesia to T6 was reduced insignificantlyby the fentanyl solutions compared with adrenaline only. Thequality of analgesia as assessed by the need for analgesic supplementswas superior for the patients given fentanyl. An observer ratingof pain and visual analogue pain scoring by the patient alsoindicated superior analgesia with fentanyl supplementation.Two patients experienced respiratory depression after extraduralfentanyl and were given naloxone. Two neonates were also givennaloxone. Close supervision is therefore recommended in theearly postoperative period when this technique is used.