Comparative Evaluation of Intrathecal Bupivacaine 0.5% With Intrathecal Bupivacaine 0.5% and 60-µg Buprenorphine for Postoperative Analgesia in Elective Cesarean Section Patients.

Introduction: The analgesia after the C-section is a very challenging condition to the anesthetist. Various combinations of the agents have been proposed for a successful analgesia. Hence, in our study, we aimed to compare the intrathecal bupivacaine 0.5% with intrathecal bupivacaine 0.5% and 60-microgram buprenorphine for postoperative analgesia in elective C-section patients. Materials and
Methods: We piloted a prospective study among 40 subjects grouped equally as Group I - bupivacaine 0.5%, and Group II - bupivacaine 0.5% and 60-μg buprenorphine. We compared the clinical parameters for the pain relief by visual analog scale (VAS), the duration of the analgesia, and the side effects for the two groups. The values obtained were compared using the ANOVA test deliberating P < 0.05 as significant.
Results: Significant longer duration and faster onset of the analgesia were seen for the Group II than the Group I. The VAS score was higher for the Group I than Group II. Greater side effects were seen in the buprenorphine group.
Conclusion: Within the limits of this study, beneficial effect of the bupivacaine was identified when added to the routine bupivacaine for the analgesia in the C-section. Copyright:

INTRODUCTION

The management of the pain is a challenge to the medical fraternity. In the recent times, many modalities have been proposed to successfully treat the postoperative pain. The C-section has been more preferred modality of the delivery recently.[12] The management of the postoperative pain in the patients after the C-section is essential as it impacts the mother and the infant. Pain relief improves the condition for the mother due to quick mobilization and the helps nurse the infant. The opioid analgesics have been used for many years in the pain management as well as the nonsteroidal anti-inflammatory drugs. Buprenorphine is one of the more potent and the long-lasting opioid.[34] This drug can be safely administered for the effectively analgesia that is effective at even very less doses. Previous studies have shown the effective application of the buprenorphine with the anesthetic; however, the dosage and the adverse effects were debatable. Hence, in our study, we aimed to compare the intrathecal bupivacaine 0.5% and the combination of the same anesthetic with 60-microgram buprenorphine among the postoperative analgesia in elective C-section patients.

MATERIALS AND METHODS

We piloted a prospective observational study among 40 age-matched subjects who were admitted for the C-section. The institutional ethics clearance was obtained, and the patient consent was taken after they were explained about the procedure. All patients were free of any other medical conditions and were not on any other medications. The subjects were randomly grouped equally as Group I – bupivacaine 0.5% and Group II – bupivacaine 0.5% and 60-microgram buprenorphine.

Following the guidelines, the subjects were given the intrathecal anesthetic for Group I and the combination was given for the Group II by the anesthetist. The surgery was performed with no complications. The investigator was blinded before taking the data. We compared the clinical parameters for the pain relief by VAS and the duration of the analgesia as well as the side effects for the two groups. The side effects were noted such as “postoperative nausea and vomiting (PONV),” and sedation was also noted. The observations were collected, and the data were compared between the groups using the IBM SPSS ver. 20 ((IBM Corp., Armonk, N.Y., USA). The analysis was done using the ANOVA test deliberating the P < 0.05 as significant.

RESULTS

We observed that there was no significant variation in the age, height, and weight. There was a significant variation for all the parameters between the groups except PONV. The greater number of the rescue analgesics was given for the Group I, while analgesia duration was longer and the onset was quicker for the Group II. The VAS score was lower for the Group II; however, the postoperative complications were also greater [Table 1].

Table 1

Comparison of the groups for the various clinical parameters

Variable	Group I	Group II	P
Number of rescue analgesia	2.3	1.02	0.05
Time of the analgesia after the analgesia	2.85±1.7	10.4±7.4	0.02
Onset of analgesia	3.52±2.2	3.02±5.21	0.057
Postoperative side effects
PONV (n)	1	4	0.02
Sedation	1	3	0.05
VAS (mean at different hours)	7	4	0.0001

PONV: Postoperative nausea and vomiting, VAS: Visual analog scale

DISCUSSION

The findings of the our study regarding the duration of the analgesia (10.4 ± 7.4 h) are comparable to the study of Capogna et al.,[2] and Dixit[4] where the combination with the 60-μg buprenorphine showed a greater duration of the postoperative analgesia among their subjects. The greater affinity of the opioid to the μ receptors prolongs the action as well as the low disassociation might be the reason.[56] Similar to our study in the study of Singh et al.,[1] rescue analgesics were lower in the buprenorphine group.

The side effects of the PONV and the sedation in our study were similar to other studies. We observed greater side effects in the combination groups than the anesthetic group. No subjects showed respiratory depression nor any neonates showed any abnormalities in the present study. The VAS was lower for the combination group which is similar to the study of Dixit[1] and Ipe et al.[7]

There were few limitations in our study, the first being a small sample size. We compared exclusively for analgesia while the effect on the hemodynamic was not investigated in our study. The neonate was only clinically evaluated using the Apgar score, while the effect of the drug was not assessed from the blood gas analysis from the umbilical cord.

CONCLUSION

Within the limitations of the study, we can suggest that the combination of the 60-μg buprenorphine to the anesthetic has improved the analgesic efficiency among the patients after the C-section than the bupivacaine alone. However, further studies with a larger sample are suggested to corroborate our findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.