title: Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery.
abstract: 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 microg), or sufentanil (2.5 and 5 microg), 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 microg, 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.
  
  
  CONCLUSIONS
  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 microg, complete and effective analgesia were significantly prolonged.
authors.affiliation: *Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany, and †Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Paul
authors.initials: P
authors.lastname: Kessler
authors.forename: Jonas
authors.initials: J
authors.lastname: Nordmeyer
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Alparslan
authors.forename: Brian A
authors.initials: BA
authors.lastname: Hall
authors.forename: Dorothee H
authors.initials: DH
authors.lastname: Bremerich
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D008619:Mepivacaine / Q000008:administration & dosage / Q000009:adverse effects; D009046:Motor Neurons / Q000187:drug effects; D009407:Nerve Block; D009475:Neurons, Afferent / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D017409:Sufentanil; D008619:Mepivacaine; D005283:Fentanyl