Background: Hemodynamic instability, including hypotension and bradycardia, can occur due to spinal anesthesia by bupivacaine. However, it is possible to reduce the chance of hemodynamic changes by the reduction of the dose of bupivacaine and/or the addition of adjunctive agents.
Objective: This study aimed to compare the effects of the addition of intrathecal dexmedetomidine and sufentanil to spinal anesthesia with bupivacaine in elective cesarean section (CS).
Methods: This prospective single-blinded randomized clinical trial with parallel groups was performed on 60 pregnant women who were candidates for elective CS in Imam Reza Hospital in Kermanshah, Iran. In addition to receiving 10 mg of hyperbaric bupivacaine 0.5%, they were randomly divided into two groups to receive intrathecal sufentanil 5 μg (30 cases) or dexmedetomidine 5 μg (30 cases). Changes in blood pressure, heart rate, and occurrence of side effects (e.g., nausea, vomiting, headache, and shivering) were recorded within 1 h after the injections. Moreover, the postoperative analgesia rate and duration (using a visual analog scale [VAS]) were recorded within the first 24 h after the completion of the CS. Headache severity (using a VAS) was also measured during the first week after CS.
Results: Patients declared their satisfaction with analgesia after surgery. No significant difference was found between the two groups in terms of heart rate and systolic and diastolic blood pressure changes during the first 60 min. Similarly, no significant difference was observed between the two groups in terms of the severity of incision pain in the first 24 h after CS surgery. On days 3, 4, and 5, none of the patients in the sufentanil and bupivacaine group had headaches (VAS=0), but patients in the dexmedetomidine and bupivacaine group had some degree of headache (P=0.040).
Conclusions: Based on the results, intrathecal administration of bupivacaine with either sufentanil or dexmedetomidine in CS did not have significantly different effects, except for slightly more severe headaches in the dexmedetomidine group. Therefore, no superiority of one drug over the other was observed for intrathecal administration with bupivacaine in CS.
Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and meta-analysis. Br J Anaesth. 2011;107(3):308-18. doi:10.1093/bja/aer200. [PubMed:21764820]
Atashkhoei S, Abedini N, Pourfathi H, Znoz AB, Marandi PH. Baricity of Bupivacaine on maternal hemodynamics after spinal anesthesia for Cesarean section: A randomized controlled trial. Iran J Med Sci. 2017;42(2):136-43. [PubMed:28360439]
Demir A, Kaya AG, Yavuz B, Kantekin CU, Basar H. The comparison of the effects of epidural Bupivacaine and Levobupivacaine on the autonomic nervous system and cardiac arrhythmia parameters in inguinal hernia surgeries. Turk J Anaesthesiol Reanim. 2015;43(2):78-83. doi:10.5152/TJAR.2014.34635. [PubMed:27366472]
Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local Reg Anesth. 2017;10:83-90. doi:10.2147/LRA.S111459. [PMID:28860857]
Farzi F, Mirmansouri A, Naderi Nabi B, Atrkar Roushan Z, Ghazanfar Tehran S, Nematollahi Sani M, et al. Comparing the effect of adding Fentanyl, Sufentanil, and placebo with intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing Cesarean section. Anesth Pain Med. 2017;7(5):e12738. doi:10.5812/aapm.12738. [PMID:29696107]
He L, Xu JM, Liu SM, Chen ZJ, Li X, Zhu R. Intrathecal Dexmedetomidine alleviates shivering during Cesarean delivery under spinal anesthesia. Biol Pharm Bull. 2017;40(2):169-73. doi:10.1248/bpb.b16-00651. [PubMed:28154256]
Qi X, Chen D, Li G, Huang X, Li Y, Wang X, et al. Comparison of intrathecal Dexmedetomidine with Morphine as adjuvants in Cesarean sections. Biol Pharm Bull. 2016;39(9):1455-60. doi:10.1248/bpb.b16-00145. [PubMed:27349272]
Hu J, Zhang C, Yan J, Wang R, Wang Y, Xu M. Sufentanil and Bupivacaine combination versus Bupivacaine alone for spinal anesthesia during Cesarean delivery: A meta-analysis of randomized trials. PloS One. 2016;11(3):e0152605. doi:10.1371/journal.pone.0152605
Maciejewski D. Sufentanil in anaesthesiology and intensive therapy. Anaesthesiol Intensive Ther. 2012;44(1):35-41. [PubMed:23801512]
Zhu H, Chen Y, Huang S, Sun X. Interaction of analgesic effects of dezocine and sufentanil for relief of postoperative pain: a pilot study. Drug Des Devel Ther. 2020;14:4717. doi:10.2147/DDDT.S270478. [PubMed:33177808]
Chen X, Qian X, Fu F, Lu H, Bein B. Intrathecal sufentanil decreases the median effective dose (ED50) of intrathecal hyperbaric ropivacaine for caesarean delivery. Acta Anaesthesiol Scand. 2010;54(3):284-90. doi:10.1111/j.1399-6576.2009.02051.x. [PubMed:19650804]
Dourado AD, Filho RL, Fernandes RA, Gondim MC, Nogueira EV. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial. Rev Bras Anestesiol. 2016;66(6):622-7. doi:10.1016/j.bjane.2015.05.002.
Lee JH, Chung KH, Lee JY, Chun DH, Yang HJ, Ko TK, et al. Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol. 2011;60(2):103-8. doi:10.4097/kjae.2011.60.2.103. [PMID:21390165]
Yousef AA, Salem HA, Moustafa MZ. Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study. J Anesth. 2015;29(5):708-14. doi:10.1007/s00540-015-2027-7. [PubMed:26006222]
Rahimzadeh P, Faiz SHR, Imani F, Derakhshan P, Amniati S. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs. BMC Anesthesiol. 2018;18(1):62. doi:10.1186/s12871-018-0531-7. [PubMed:29875020]
Sun Y, Xu Y, Wang GN. Comparative evaluation of intrathecal Bupivacaine alone, Bupivacaine-fentanyl, and Bupivacaine-dexmedetomidine in Caesarean section. Drug res. 2015;65(9):468-72. doi:10.1055/s-0034-1387740. [PubMed:25207707]
Magdy H, Mohsen M, Saleh M. The effect of intrathecal compared with intravenous dexmedetomidine as an adjuvant to spinal bupivacaine anesthesia for cesarean section. Ain Shams J Anesthesiol. 2015;8(1):93. doi:10.4103/1687-7934.153949.
Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, Murshidi MM, Ammari BA, Awwad ZM, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30(3):365-70. [PubMed:19271064]
Nasseri K, Ghadami N, Nouri B. Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial. Drug Des Devel Ther. 2017;11:1107-13. doi:10.2147/DDDT.S131866. [PubMed:28435222]
Shaikh SI, Mahesh SB. The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries. J Anaesthesiol Clin Pharmacol. 2016;32(2):203-9. doi:10.4103/0970-9185.182104. [PubMed:27275050]
Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg. 1997;85(6):1288-93. doi:10.1097/00000539-199712000-00020. [PubMed:9390596]