背景和目的脊柱麻醉是下段剖宫产(LSCS)患者的基石,提供更快的起效和高块密度等优点。左旋布比卡因,以其高效和长效特性而闻名,起病较慢。评价鞘内注射芬太尼或咪达唑仑作为左布比卡因辅助用药的安全性。这项研究旨在比较选择性剖宫产术中添加0.5%高压左布比卡因的芬太尼或咪达唑仑提供的术后镇痛时间。次要目标包括评估感觉和运动阻滞的发作和持续时间以及恶心和呕吐的发生率。确定更有效的佐剂将有助于优化脊髓麻醉方案,改善术后结果,并提高患者的舒适度和恢复。方法本研究在SRM医学院附属医院和研究中心进行,钦奈,印度,超过六个月(2023年5月1日至2023年10月1日)。在一项前瞻性随机双盲对照试验中,共有90例接受择期LSCS的患者接受了脊髓麻醉。患者被分为三组:A组接受左旋布比卡因和芬太尼,B组接受左布比卡因和咪达唑仑,C组给予左旋布比卡因生理盐水。块特性,术后镇痛,血液动力学稳定性,并对并发症进行了评估。在指定的时间点进行评估:术中,前30分钟每5分钟,接下来的一个小时每10分钟,每两个小时六个小时,术后每4小时到24小时。统计分析使用单向方差分析(ANOVA)。结果与A组和C组(均为145秒)相比,B组(左布比卡因联合咪达唑仑)表现出更短的感觉阻滞开始时间(88秒)(p<0.001)。A组(左旋布比卡因加芬太尼)的最大运动阻滞时间(p=0.045)短于B组和C组。A组(127.5分钟)的感觉阻滞持续时间明显长于B组(60分钟)和C组(69分钟)(p<0.001)。与B组(147分钟)和C组(177分钟)相比,A组(251分钟)的运动阻滞持续时间也延长(p=0.045)。A组的第一次镇痛需求延迟(248分钟),而B组(115分钟)和C组(90分钟)(p<0.001)需要更频繁的镇痛。A组术后恶心呕吐发生率较高。结论咪达唑仑加速感觉阻滞的发作,而芬太尼延长麻醉持续时间,而不显著影响运动阻滞。芬太尼延迟了第一次镇痛需求,而咪达唑仑减少了术后恶心,呕吐,颤抖着。
Background and objectives Spinal anesthesia stands as a cornerstone for patients undergoing lower segment cesarean section (LSCS), offering advantages like faster onset and high block density. Levobupivacaine, known for its high potency and long-acting nature, has a slower onset. The safety of intrathecal fentanyl or midazolam is evaluated as an adjuvant to levobupivacaine in parturients. This
study aims to compare the duration of postoperative analgesia provided by fentanyl or midazolam added to 0.5% hyperbaric levobupivacaine in elective cesarean sections. Secondary objectives include evaluating the onset and duration of sensory and motor blockade and the incidence of nausea and vomiting. Identifying the more effective adjuvant will help optimize spinal anesthesia protocols, improve postoperative outcomes, and enhance patient comfort and recovery. Methods This
study was conducted at SRM Medical College Hospital and Research Centre, Chennai, India, over six months (May 1, 2023, to October 1, 2023). A total of 90 patients undergoing elective LSCS received spinal anesthesia in a prospective randomized double-blinded controlled
trial. Patients were allocated to three groups: Group A received levobupivacaine with fentanyl, Group B received levobupivacaine with midazolam, and Group C received levobupivacaine with normal saline. Block characteristics, postoperative analgesia, hemodynamic stability, and complications were assessed. Assessments were conducted at specified time points: intraoperatively, every five minutes for the first 30 minutes, every 10 minutes for the next hour, every two hours for six hours, and every four hours up to 24 hours postoperatively. Statistical analysis utilized one-way analysis of variance (ANOVA). Results Group B (levobupivacaine with midazolam) exhibited a shorter time to sensory block onset (88 seconds) compared to Groups A and C (both 145 seconds) (p < 0.001). Group A (levobupivacaine with fentanyl) showed a shorter time to maximum motor block (p = 0.045) than Groups B and C. The sensory block duration was significantly longer in Group A (127.5 minutes) compared to Group B (60 minutes) and Group C (69 minutes) (p < 0.001). Motor block duration was also prolonged in Group A (251 minutes) compared to Group B (147 minutes) and Group C (177 minutes) (p = 0.045). The first analgesic requirement was delayed in Group A (248 minutes), whereas Groups B (115 minutes) and C (90 minutes) (p < 0.001) required more frequent analgesia. Group A experienced a higher incidence of postoperative nausea and vomiting. Conclusion Midazolam accelerated sensory block onset, while fentanyl prolonged anesthesia duration without significantly affecting motor block. Fentanyl delayed the first analgesic requirement, whereas midazolam reduced postoperative nausea, vomiting, and shivering.