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Title

ASSESSING THE EFFECT OF INTRATHECAL ALFENTANIL IN THE QUALITY AND DURATION OF SPINAL ANESTHESIA IN CESAREAN SECTION AND SIDE EFFECTS: A RANDOMIZE CLINICAL TRIAL

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 Start Page 33 | End Page 38

Abstract

 Background and Objectives: The use of neuraxial opioids has gained popularity over the last few years; they may cause analgesia by the local anesthetic through direct binding with the specific SPINAL receptors. The purpose of this study was to compare the effect of intrathecal ALFENTANIL in patients undergoing CESAREAN SECTION on SPINAL ANESTHESIA during the operation, and after the operation on SPINAL ANESTHESIA and side effects.Methods: The study was a randomized prospective and double blind study. 60 young adult females, with ASA physical status I and II with singleton pregnancy undergoing elective CESAREAN SECTION under SPINAL ANESTHESIA were randomly allocated to receive SPINAL elective ANESTHESIA either by using 0.5% hyperbaric BUPIVACAINE 2.5 ml with 0.5 ml normal saline (saline group) or with 0.5ml ALFENTANIL (alfentanil group). Blood pressure, heart rate, respiratory rate, oxygen saturation and side effects were observed before SPINAL ANESTHESIA and every 5 minutes interval during the surgery, therefore at 30 minute interval until the patient complained of pain. Intraoprative quality of analgesia during SPINAL ANESTHESIA, time of first feeling of pain (complete analgesia), time of first request of analgesics postoperatively (effective analgesia), side effects (nausea, vomiting, shivering, Purities) and fetal outcomes were evaluated and analyzed.Results: It was shown that 90% of patients in ALFENTANIL group had excellent analgesia Intraopratively, while only 16.7% of patients in the saline group had an analgesia which was qualified as excellent (p<0.001). Complete analgesia also lasted longer in ALFENTANIL group (178±41.8min) compared with saline group (97±28.9min) (p<0.01). The duration of effective analgesia was significantly shorter in the saline group (132±0.32min) compared with the ALFENTANIL group (223.5±0.40.9min) (p<0.01). Hemodynamic variables were similar in both groups (p>0.05). Purities were the most common side effect in the ALFENTANIL group (76.7% of patients). Nausea was less present in ALFENTANIL group than in saline group (50% versus 85%). The incidence of shivering and vomiting did not differ between two groups (p>0.05). APGAR scores were similar in both groups (p>0.05).Conclusion: The addition of ALFENTANIL 250 micrograms to hyperbaric BUPIVACAINE 12.5mg for SPINAL ANESTHESIA increased the quality of surgical analgesia and duration of postoperative analgesia in patients undergoing CESAREAN SECTION without increased any side effects. Purities were the most common side effects but they were mild.

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