Objective: After the discovery of opioid receptors in the spinal cord and direct opioid action at this level, possibility of synergism between opioids and local anaesthetics co-administered intrathecally has been explored in obstetric population undergoing LSCS. The synergistic action of local anaesthetic with opioid is of great benefit in achieving adequate anaesthesia with lesser dose of local anaesthetics thereby reducing the chances and severity of hypotension and to provide postoperative analgesia for longer duration.

Design: The study was conducted in 90 parturients divided in two groups of 45 each scheduled to undergo elective Lower Segment Caesarian Section under spinal anaesthesia. After securing iv line, Group I patients received 0.5% (H) hyperbaric bupivacaine 10mg and Group II received 0.5%(H) Bupivacaine and 12.5mcg fentanyl intrathecally in L3-L4 space in left lateral position. After spinal, patients were made supine with wedge kept under right hip. All patients were assessed for time of onset of sensory analgesia ,maximum level of sensory blockade achieved, degree of motor blockade(Modified Bromage score),Duration of effective analgesia, any possible side effects

Results: The time of onset of analgesia was shortened in Group II. In both groups mean height of analgesia was T4.The mean time to achieve highest sensory level was 3.96±1.65 min in Group II as compared to 5.29±1.93 min in Group I. Mean time for complete sensory recovery was 277.2±33.33 min in Group II as compared to 185±29.8 min in Group I which was significant. Total duration of analgesia was prolonged in Group II, there were no significant side effects.

Conclusions: From this study, we conclude that addition of 12.5 mcg of fentanyl decreases the time of onset of sensory analgesia, improves the quality of intraoperative anaesthesia, prolongs the duration of sensory analgesia without having significant effect on characteristics of motor blockade. It does not cause any significant haemodynamic changes and side effects in mother as well as neonate. It also reduced the demand for postoperative analgesia

Keywords: Bupivacaine, Fentanyl, Lower segment caesarean section, Subarachnoid block.

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Dr Dilip Rana