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Rom J Anaesth Intensive Care. 2015 Oct;22(2):97-102.

Effects of fentanyl added to a mixture of intrathecal bupivacaine and morphine for spinal anaesthesia in elective caesearean section.

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Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton Road, Cork, Ireland.
University College Cork, National University of Ireland, Cork, Ireland.


in English, Romanian


The use of either fentanyl or morphine intrathecally as adjuncts to bupivacaine for spinal anaesthesia in caesarean deliveries is commonplace. However, the use of fentanyl in combination with morphine and bupivacaine in elective caesarean section is debatable. We hypothesized that while the addition of intrathecal fentanyl to morphine and bupivacaine increases side effects, it does not improve the clinical quality of anaesthesia or analgesia in elective caesarean deliveries.


In this case-controlled, double-blinded study, women undergoing elective caesarean deliveries received intrathecal fentanyl plus morphine with bupivacaine (Group 1) or intrathecal morphine with bupivacaine alone (Group 2). Patients were assessed at 4 hours for pain at rest and on movement using the visual analog scale (VAS), time taken for sensory block to T6 and side effects.


Fifty patients were randomized into Group 1 (n = 25) and Group 2 (n = 25). There was no difference in the mean VAS scores at rest or on movement between the two groups. At 4 hours, the mean (SD) VAS scores at rest were 13.2 (13.7) mm and 12.0 (11.5) mm in Group 1 and 2, respectively (P = 0.739). The mean (SD) VAS scores on movement in Group 1 were 38.0 (18.2) mm, and in Group 2 were 28.4 (12.4) mm (P = 0.349). Group 1 took 7.34 hours to the first request for postoperative opioid analgesia while Group 2 took 7.08 hours (P = 0.749). Correspondingly, patient satisfaction ratings were comparable for both groups, the mean (SD) rating in Group 1 at 84.4 (11.11) compared to Group 2 at 87.6 (9.02), (P = 0.269). Patients in both groups had similar onset of T6 block. The incidence of side effects was higher in Group 1 than Group 2.


Our study found that the addition of intrathecal fentanyl to morphine and bupivacaine did not have an advantage for short-term postoperative analgesia, but increased the incidence of opioid-related side effects and thus cost of care in a maternal population attending for elective caesarean section.


caesarean section; fentanyl; intrathecal; morphine; pain


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