Spinal Anesthesia for Cesarean Section. Use of Hyperbaric Bupivacaine (10 mg) Combined with Different Adjuvants

Braga AA, Frias JAF, Braga FS, Poterio GB, Hirata ES, Torres NA - Spinal Anesthesia for Cesarean Section. Use of Hyperbaric Bupivacaine (10 mg) Combined with Different Adjuvants. Background and objectives: Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section. Method: Prospective, randomized, blinded study of 96 patients allocated into four groups: Group I (no adjuvant), Group II (sufentanil 5.0 mu g), Group III (morphine 100 mu g), and Group IV (clonidine 75 mu g). It was evaluated the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-fetal repercussions. Results: The onset of blockade was significantly faster in groups with adjuvants compared with Group I. Patients in Groups I and III reported pain during the perioperative period. Duration of analgesia was significantly higher in Group II and time to motor block recovery was significantly higher in Group IV. Pruritus occurred in Groups II and III. Sedation was significant in Group IV and there was prolonged arterial hypotension in Group IV. Conclusion: Addition of sufentanil and clonidine to hyperbaric bupivacaine provided adequate anesthesia for cesarean section and good postoperative analgesia. Clonidine caused more perioperative sedation and longer time to motor block recovery. Pruritus was evident when opioids were used.