Assessment of the effect of intrathecal bupivacaine combined with opioids on postoperative analgesia in patients undergoing cesarean section

Purpose: Our prospective, randomized, double-blind study aimed to detect the effect of intrathecal bupivacaine combined with opioids on the postoperative analgesia in patients undergoing cesarean section. Material and Methods: 1110 patients with gestational age over 37 weeks, over 18 years of age and who undergoing elective cesarean section with spinal anesthesia were into the following three groups according to intrathecal opioids: Group 1: 8 mg 5% hyperbaric bupivacaine and 20 mcg fentanyl, Group 2: 8 mg 5% hyperbaric bupivacaine and 20 mcg fentanyl + 50 mcg morphine, Group 3: 8 mg 5% hyperbaric bupivacaine and 20 mcg fentanyl + 100 mcg morphine. First analgesic requirement time, intraoperative and postoperative side effects, intraoperative visual analog scale (VAS) were recorded. Results: 1090 patients were included in the statistical evaluation. Intraoperative nausea and vomiting were significantly less in the Group 3 (p=0.047). Intraoperative pruritus was significantly higher in Group 3 compared to the other two groups (p<0.001). There was no difference between the groups in terms of intraoperative VAS values. Postoperative nausea, vomiting, pruritus, hypotension, bradycardia were similar among the groups. Patient satisfaction was lowest in Group 1 and highest in Group 3 (p<0.001). The duration of first analgesia was short in Group 1 (p<0.001). Conclusions: We concluded that, morphine added to bupivacaine and fentanyl for spinal anesthesia increased the duration of the first analgesic requirement and that 50 and 100 mcg of morphine were not superior to each other in terms of side effects and first analgesic duration.