Abstract
Epidural fentanyl is often added to epidural local anaesthetic agents to improve the quality of anaesthesia obtained during Caesarean section. Fentanyl may be given either before or after delivery of the infant. When given before delivery, fentanyl has not been reported to cause neonatal depression, although this remains a concern. A prospective, randomized, double-blind study was undertaken to determine if fentanyl was more effective if given before or after delivery of the baby in 64 women undergoing Caesarean section under lidocaine epidural anaesthesia. Maternal outcome was determined by time to achieve T4 neural blockade, the dose of lidocaine necessary to achieve this block and intraoperative scores for pain, nausea, vomiting, shivering, and sedation. Neonates were assessed by umbilical arterial blood pH and Apgar scores. No differences were detected in either group with respect to maternal or neonatal outcome. We recommend using only epidural local anaesthetic agents before delivery, and giving epidural fentanyl following delivery of the infant.
Résumé
Le fentanyl est souvent ajouté aux agents anesthésiques locaux administrés par voie épidurale afin d’améliorer la qualité de l’anesthésie au cours d’une césarienne. Le fentanyl peut être administré avant ou après la naissance. Une étude prospective, à double insu, avec distribution aléatoire, a été faite chez 64 parturientes qui ont accouché par césarienne sous anesthésie épidurale. Le but était de déterminer si le fentanyl était plus efficace lorsque donné avant la naissance. Les paramètres évalués chez la mère étaient le temps requis pour atteindre un bloc sensitif au niveau de T4, la dose de lidocaine nécessaire pour atteindre ce niveau d’anesthésie, la douleur peropératoire, le degré de sédation, ainsi que l’incidence de frissons, nausées et vomissements. L’Apgar et le pH du sang artériel ombilical ont été évalués chez les nouveaunés. Aucune différence significative n’a été trouvee entre les groupes pour chacun des paramétres évalués chez les méres et les nouveaunés. Nous recommandons d’administrer seulement l’agent anesthésique local par voie épidurale avant l’accouchement et de donner le fentanyl après la naissance.
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Breen, T.W., Janzen, J.A. Epidural fentanyl and caesarean section: when should fentanyl be given?. Can J Anaesth 39, 317–322 (1992). https://doi.org/10.1007/BF03009040
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DOI: https://doi.org/10.1007/BF03009040