Sufentanil and Bupivacaine Combination

Versus Bupivacaine Alone for Spinal

Anesthesia During Cesarean Delivery
Jiajia Hu1, Chenglliang Zhang2, Jianqin Yan1, Ruike Wang1, Yin Wang2, Mu Xu 1
1Department of Anesthesiology and 2Cardiovascular Surgery Xiangya Hospital,
Changsha, China

Pembimbing:
dr. Randolph Siahaan, Sp.An

Rizki Widya Kirana

03012236
Fakultas Kedokteran Universitas Trisakti
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 ?
“It was suggested adding opioids to
local anesthetic for spinal anesthesia
might improve anesthesia quality and
prolongs the duration of action”

Sulfentanil, a lipophilic opioid, was the most

AIM
frequent drug used in conjunction with the local • Review the analgesic efficacy and side effects of
additional sufentanil to bupivacaine for spinal anesthesia
anesthetic bupivacaine for cesarean
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delivery
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 A comprehensive literature search without language
or date limitation was performed to identify clinical
trials that compared the addition of sufentanil to
bupivacaine with bupivacaine alone for spinal
anesthesia in healthy parturients choosing cesarean
delivery

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 The study included 9 trials containing 578 patients in
the final meta- analysis

Breakthrough pain Hypotension and

vomiting

Sensory block onset Pruritus

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 Bupivacaine and sufentanil combination significantly reduced
the incidence of breakthrough pain during surgery compered with
bupivacaine alone
Breakthrough pain occurred in 10 of 138 patients sufentanil group,
and in 75 of 103 in bupivacaine alone group

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RR= 0.10, 95% CI 0.06 to 0.18 P<0.001
 Pooled result suggested that sufentanil added to
bupivacaine shortened sensory block onset time
compare with bupivacaine alone

WMD= -1.04 MIN, 95% CI -1.50 to -0.58 min; P<0.001

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 The pooled results suggested that adding sufentanil to
bupivacaine did not affect motor block duration
compered with bupivacaine alone

WMD= 29 MIN, 95% CI -19 to 76 min; P= 0.24

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 The healthy states of neonates were evaluated by
neonatal APGAR scores 1 and 5 min after delivery

Maternal side effects including hypotension, nausea,

vomiting, pruritus, and shivering were compared
between sufentanil added and bupivacaine alone
groups. There were no significant differences in the
incidence of hypotension and vomiting

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 Sufentanil addition significantly increased the
incidence of pruritus. Sufentanil addition did not affect
the incidence of nausea, however when trial Bang, et
al was removed from the analysis, the incidence of
nausea was significantly lower in the sufentanil
combined with bupivacaine group.
The pooled results showed that the incidence of
shivering was lower in the sufentanil added group

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 Spinal aneshesia is routinely used for caesarean delivery because of its ease
of control, fast onset, effective nerve block, low failure rate,
and low systemic toxicity. It can decrease the risk of airway
complications compared to general anesthesia. It has been suggested
that the addition of various opioids to local anesthetics may improve intra
and post operative analgesics effects and reduce side effects.

The present meta- analysis comparing the addition of sufentanil to

bupivacaine with bupivacaine alone for spinal anesthesia
found that addition the addition of sufentanil to bupivacaine
provided significant benefits for spinal anesthesia in healthy
parturients during caesarean delivery as compared to
bupivacaine alone

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A clinically important effect of adding lipid-soluble sufentanil to bupivacaine is the significantly
lower incidence of breakthrough pain.

Spinal anesthesia with high dose

Provided effective analgesia but
local anesthetic (e.g bupivacaine
with a high incidence of hypotension
12-15 mg)

Not only reduces the incidence of

Low dose bupivacaine combined intraoperative hypotension but also provides

with opioid reliable analgesia compared with high- dose

local anesthesic

Sufentanil and bupivacaine combination also resulted in a shorter time to sensory block and
longer first analgesic request time compared with bupivacaine alone

The high lipid solubility of sufentanil coupled with high affinity for𝜇- opioid receptors can
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explain the rapid onset of sensory block
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 PRURITUS

Incidence of pruritus was higher in

30-60% patients who
the parturients with sufentanil added
receive spinal opioids
group

Spinal triggering of itching is The increased incidence of pruritus in

observed in particular by activation pregnant women may be due to

interaction of esterogen and opioid
of 𝜇 - opioid receptors
receptor

Addition of local anesthesia seems to Pruritus invoked by lipid soluble opioids

decrease the prevalence and the such as fentanyl and sufentanil is of

shorten duration and the used of the min
severity itching
effective dose
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 Bupivacaine and sufentanil combination is superior to
that of bupivacaine alone for spinal anesthesia for caesarean

delivery in analgesia quality. Women receiving the

combined two drugs had less breakthrough pain,
shorter sensory block onset time, and longer first
analgesic request time. However, the addition of sufentanil to
bupivacaine increased the incidence of pruritus

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 THANK YOU

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