A RANDOMISED CONTROLLED TRIAL COMPARING INTRATHECAL FENTANYL-MORPHINE-BUPIVACAINE VERSUS INTRATHECAL FENTANYL-BUPIVACAINE IN WOMEN UNDERGOING CESAREAN OPERATION.
Sudhirchandra SHAH 1, Dhadappa Damodar SRIDHARAN1, Iqbal HUSSAIN1, Thomas Abraham JACOBS1, Maebelle CAYOWET1, Chee Fui CHONG2.
1Department of Anaesthesia, Suri Seri Begawan Hospital, Kuala Belait, Brunei Darussalam.
2Clinical Research Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam.
Objective: Comparison of the effectiveness and duration of Intrathecal fentanyl-morphine-bupivacaine versus intrathecal fentanyl-bupivacaine for post-operative analgesia after cesarean section. Material and Method: A prospective single blinded randomized controlled trial comparing intrathecal fentanyl-morphine-bupivacaine versus intrathecal fentanyl-bupivacaine for post-operative pain relief in caesarean section was conducted. Fifty parturient women, ASA physical status 1 and 2, were randomized into two groups. Group A received fentanyl 15 µgm, morphine 100 µgm and bupivacaine 10 mg intrathecally and Group B received fentanyl 25 µgm and bupivacaine 10 mg intrathecally. The primary outcome was quality and duration of postoperative analgesia. Block characteristic, haemodynamic variables, demand for rescue analgesia and adverse effects were also assessed. Intention to treat analysis was performed at the end of the study. P<0.05 was considered as statistical significance. Results: The demographic profiles and block characteristics were comparable in both groups except women in Group A underwent more additional procedures besides caesarean section (p=0.044). The mean total morphine requirement post-operatively for the first 24 hours in Group A was 8.73 +/- 7.39 mg and Group B was 14.95 +/- 5.86 mg respectively, which was statistically significant (p=0.004). Mean VAS score was also significantly lower in Group A 9p=0.049) as was the need for additional analgesia (p=0.024). There were two cases of pruritus in Group B and one case of vomiting in Group A. There were no cases of respiratory depression. Fetal APGAR scores were similar in both groups. Conclusion: The use of intrathecal fentanyl-morphine-bupivacaine combination resulted in a more effective and longer duration of post-operative analgesia as compare to intrathecal fentanyl-bupivacaine in parturient women undergoing cesarean section under spinal anaesthesia.
Key words: Analgesia, Bupivacaine, Cesarean section, Fentanyl, Morphine, Post-operative, Spinal anaesthesia.
Corresponding Author: Dr Shah Sudhirchandra Dhansukhlal, Department of Anaesthesia, Suri Seri Begawan Hospital, Kuala Belait, Negara Brunei Darussalam. Hp: +6738674630; email:
Brunei Int Med J.2021;17:45-54