Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section

  • Moustapha Diedhiou Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • E.B. Ba Université Cheikh Anta Diop – Dakar - Senegal
  • D Barboza Health sciences training and research unit (UFRSS) – Assane Seck University Ziguinchor – Senegal
  • A. Diouf Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • M. Dieng Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • O Thiam Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • C.A. Dia Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • N Sarr Université Cheikh Anta Diop – Dakar - Senegal
  • M.L. Fall Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal
  • M.D. Beye Université Cheikh Anta Diop – Dakar - Senegal
  • E. Diouf Université Cheikh Anta Diop – Dakar - Senegal

Abstract

Objective: Evaluation of the hemodynamic, respiratory and fetal side effects of two protocols for spinal anesthesia (P1: bupivacaine-fentanyl; P2: ropivacaine-fentanyl).


Material and Method: Prospective pseudo-randomized study comparing two spinal anesthesia protocols for emergency cesarean section conducted in the operating room of the regional hospital center of Saint Louis in Senegal. Study duration was 4 months. We studied, age, indication for Caesarean section, medical and surgical history, P1 and P2 protocols, hypotension, bradycardia, Apgar scores at birth and at 5min. Univariate and bivariate analysis was performed on the R software.


Result: A total of 115 patients were collected, with a mean age of 27.1 years (E: 15 - 45) and a standard deviation of 7.6. Indications for Caesarean section were maternal and fetal dystocia for 67 patients (58%), fetal distress for 39 parturients (34%), and pre-eclampsia for 5 patients (4%). The P1-Bupi spinal protocol was used in 42 patients (36.5%) and the P2-Ropi spinal protocol was used in 73 patients (63.5%). Anesthetic complications such as low blood pressure, bradycardia and desaturation were found in a total of 30 patients, i.e. in 26% of cases. The mean Apgar score at birth for newborns from the P1-Bupi protocol was 8 (Extremes: 7, 9); the mean Apgar score at birth for newborns from the P2-Ropi protocol was 7.5 (Extremes: 2, 10). There was a significantly negative correlation between the P1-bupi protocol and the appearance of hypotension with p-value: 0.04 and a significantly positive correlation between the P2-ropi protocol and the appearance of hypotension with p-value: 0.04.


Discussion/ Conclusion: Ropivacaine certainly has a better cardiovascular and neurological tolerance and a better efficacy in terms of analgesia. However, during caesarean sections, it is important to consider the risk of hypotension and possible fetal complications related to its use.


Keywords: Ropivacaine - Bupivacaine - Spinal anesthesia - Caesarean section

Keywords: Ropivacaine, Bupivacaine, Spinal anesthesia, Caesarean section

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Author Biographies

Moustapha Diedhiou, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

E.B. Ba, Université Cheikh Anta Diop – Dakar - Senegal

Université Cheikh Anta Diop – Dakar - Senegal

D Barboza, Health sciences training and research unit (UFRSS) – Assane Seck University Ziguinchor – Senegal

Health sciences training and research unit (UFRSS) – Assane Seck University Ziguinchor – Senegal

A. Diouf, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

M. Dieng, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

O Thiam, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

C.A. Dia, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

N Sarr, Université Cheikh Anta Diop – Dakar - Senegal

Université Cheikh Anta Diop – Dakar - Senegal

M.L. Fall, Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

Health sciences training and research unit (UFRSS) - Gaston Berger University-Saint Louis Regional hospital - Senegal

M.D. Beye, Université Cheikh Anta Diop – Dakar - Senegal

Université Cheikh Anta Diop – Dakar - Senegal

E. Diouf, Université Cheikh Anta Diop – Dakar - Senegal

Université Cheikh Anta Diop – Dakar - Senegal

References

1. Bonnin, M., Storme, B., & Fournet-Fayard, A. Anesthésie pour césarienne: les principales méthodes et leurs indications. Douleur et Analgésie, 2016; 29(2):88-93.
2. Deleuze, A., & Gentili, M. Ropivacaïne en rachianesthésie et chirurgie ambulatoire. Le Praticien en Anesthésie Réanimation, 2006; 10(4):296-298.
3. Hansen TG. Ropivacaine: A pharmacological review. Expert Rev Neurother. 2004; 4:78191. [PubMed] [Google Scholar]
4. Kindler CH, Paul M, Zou H, Liu C, Winegar BD, Gray AT, et al. Amide local anaesthetics potently inhibit the human tandem pore domain background K+ channel TASK-2 (KCNK5) J Pharmacol Exp Ther. 2003; 306:84–92. [PubMed] [Google Scholar]
5. Kuthiala, G., & Chaudhary, G. Ropivacaine: A review of its pharmacology and clinical use. Indian journal of anaesthesia, 2011; 55(2):104.
6. Selander D, Sjovall J, Waldenlind L. Accidental i.v injections of ropivacaine: Clinical experience of six cases [abstract] Reg Anaesth. 1997; 22:70. [Google Scholar]
7. Chang DH, Ladd LA, Copeland S, Iglesias MA, Plummer JL, Mather LE. Direct cardiac effects of intracoronary bupivacaine, levobupivacaine and ropivacaine in the sheep. Br J Pharmacol 2001; 132:649–58
8. Santos AC, Arthur GR, Wlody D, De Armas P, Morishima HO, Finster M. Comparative systemic toxicity of ropivacaine and bupivacaine in nonpregnant and pregnant ewes. Anesthesiology 1995; 82:734–40
9.Nancarrow C, Rutten AJ, Runciman WB, Mather LE, Carapetis RJ, McLean CF, Hipkins SF. Myocardial and cerebral drug concentrations and the mechanisms of death after fatal intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg 1989; 69:276–83
10. Feldman HS, Arthur GR, Covino BG. Comparative systemic toxicity of convulsant and supraconvulsant doses of intravenous ropivacaine, bupivacaine and lidocaine in the conscious dog. Anesth Analg 1989; 69:794–801
11. Morishima HO, Pedersen H, Finster M, Hiraoka H, Tsuji A, Feldman HS, Arthur GR, Covino BG. Bupivacaine toxicity inpregnant and nonpregnant ewes. Anesthesiology 1985; 63:134
12. Beilin, Y., & Halpern, S. Ropivacaine versus bupivacaine for epidural labor analgesia. Anesthesia & Analgesia, 2010; 111(2):482-487.
13. Graf, B. M., Abraham, I., Eberbach, N., Kunst, G., Stowe, D. F., & Martin, E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology: The Journal of the American Society of Anesthesiologists, 2002; 96(6):1427-1434.
14. Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: A review of its use in regional anaesthesia and acute pain management. Drugs. 2005; 65:2 675–717. [PubMed] [Google Scholar]
15. Burm AG, Stienstra R, Brouwer RP, Emanuelsson BM, van Kleef JW. Epidural infusion of ropivacaine for postoperative analgesia after major orthopedic surgery: Pharmacokinetic evaluation. Anesthesiology. 2000; 93:395–403. [PubMed] [Google Scholar]
16. Ala-Kokko TI, Alahuhta S, Jouppila P, Korpi K, Westerling P, Vähäkangas K. Feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section. Int J Obstet Anesth. 1997; 6:147–52.[PubMed] [Google Scholar]
17. Ferré, F., Martin, C., & Minville, V. Contrôle de la pression artérielle en rachianesthésie. Anesthésie & Réanimation, 2017; 3(2):147-155.
18. Fischer, C., & Mercier, F. J. Rachi ou Rachi-péRi pouR la césaRienne?.
19. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section (review). The Cochrane Library 2009.
20. Ginosar Y, Mirikatani E, Drover DR, Cohen SE, Riley ET. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology 2004; 100:676-82.
21. Hallworth SP, Fernando R, Columb MO, Stocks GM. The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg 2005; 100:1159-65.
22. Mercier FJ, Riley ET, Frederickson WL, Roger-Christoph S, Benhamou D, Cohen SE. Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section. Anesthesiology 2001; 95:668-74.
23. Dyer RA, Farina Z, Joubert IA, Du Toit P, Meyer M, Torr G, Wells K, James MF. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective cesarean section. Anaesth Intensive Care 2004; 32:351-7
24. Richez, B., Saltel, L., Julliac, B., Soulard, A., Millas, E., & Sztark, F. Anesthésie maternelle durant l’accouchement: effets maternels et fœtaux, devenir cognitif du nouveau-né. Revue de médecine périnatale, 2013 5(4)2 :22-229.
25. Maayan-Metzger A, Schushan-Eisen I, Todris L, et al, Maternal hypotension during elective cesarean section and shortterm neonatal outcome. Am J Obstet Gynecol 2010; 202(1):56e1e5
26. Reynolds F, Seed PT, Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005; 60(7):636–53
27. Ross MG, Gala R, Use of umbilical artery base excess: algorithm for the timing of hypoxic injury. Am J Obstet Gynecol 2002; 187(1):1–9
28. Habib AS, A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2012; 114(2):377–90
29. Veeser M, Hofmann T, Roth R, et al, Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative metaanalysis. Acta Anaesthesiol Scand 2012; 56(7):810–6
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Diedhiou M, Ba E, Barboza D, Diouf A, Dieng M, Thiam O, Dia C, Sarr N, Fall M, Beye M, Diouf E. Bupivacaine-Fentanyl vs Ropivacaine-Fentanyl: Evaluation of two Spinal Anesthesia Protocols for Emergency Cesarean Section. JDDT [Internet]. 15Dec.2020 [cited 21Jan.2021];10(6-s):3-. Available from: http://jddtonline.info/index.php/jddt/article/view/4403