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OBSTETRIC ANESTHESIA

Intrathecal Fentanyl, Sufentanil, or Placebo Combined with Hyperbaric Mepivacaine 2% for Parturients Undergoing Elective Cesarean Delivery

Dirk Meininger, MD^*, Christian Byhahn, MD^*, Paul Kessler, MD^*, Jonas Nordmeyer, MD^*, Yasmin Alparslan^*, Brian A. Hall, MD, and Dorothee H. Bremerich, MD^*

*Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany, and Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Dorothee H. Bremerich, MD, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe-University Clinic, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany. Address e-mail to bremerich{at}em.uni-frankfurt.de

Worldwide, long-acting bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With advances in surgical techniques, e.g., the Misgav Ladach method, and shorter duration of surgery, the local anesthetic mepivacaine, with an intermediate duration of action, may be a reasonable alternative. Our aim in the present study was to evaluate the effects of 2% hyperbaric mepivacaine alone, or combined with either intrathecal fentanyl (5 and 10 µg), or sufentanil (2.5 and 5 µg), on sensory, motor, and analgesic block characteristics, hemodynamic variables, and neonatal outcome in a randomized, prospective, and double-blinded study (n = 100, 20 parturients per group, singleton pregnancy, >37 wk of gestation). No parturient experienced intraoperative pain. The average duration of motor block Bromage 3 in all groups was 68 min, and resolution time to Bromage 0 was 118 min. Maximal cephalad sensory block level was T3-6 and could be established within 6 min. Complete analgesia was significantly prolonged in all groups receiving intrathecal opioids, yet, with sufentanil 5 µg, even the duration of effective analgesia was significantly extended. Neonatal outcome was not affected by intrathecal opioid administration. In conclusion, 2% hyperbaric mepivacaine is a feasible local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery, particularly with short duration of surgery.

IMPLICATIONS: Sensory, motor, and analgesic block characteristics of the local anesthetic mepivacaine alone or combined with intrathecal opioids were studied in parturients undergoing elective cesarean delivery in a randomized, double-blinded clinical trial. Mepivacaine was found to be an acceptable local anesthetic for spinal anesthesia in parturients undergoing cesarean delivery. In combination with sufentanil 5 µg, complete and effective analgesia were significantly prolonged.

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