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    Comparison of the effects of two different low-doses of isobaric bupivacaine on intraoperative hemodynamics under spinal anaesthesia during caesarean section: a randomized controlled trial
    (IMR Press Limited, 2023) Dostbil, Ayşenur; Atalay, Canan; İnce, İlker; Aksoy, Mehmet; Özmen, Özgur; Kasali, Kamber; Yapca, Ömer Erkan; Küçün, Tuğberk; Aksoy, Ayşe Nur; Şenocak, Gamze Nur Cimilli
    Background: The objective of this study was to conduct a randomized controlled trial in order to examine the hemodynamic impacts of two different doses of intrathecal isobaric bupivacaine (5 mg and 7 mg) when combined with 15 μg fentanyl in the context of patients undergoing caesarean section under combined spinal epidural anesthesia. Methods: Eighty patients with American Society of Anesthesiologists physical status I and II, aged between 16-50 years, who would undergo elective caesarean section under combined spinal epidural anaesthesia were randomly allocated to Group A and Group B (n = 40, for each group). Group A patients received a solution containing 5 mg isobaric bupivacaine + 15 μg fentanyl (1.3 mL), while Group B patients received a solution containing 7 mg isobaric bupivacaine + 15 μg fentanyl (1.7 mL) intrathecally. Incidences of hypotension, intraoperative systolic blood pressure, diastolic blood pressure, heart rate, motor block resolving time, and analgesia duration were recorded. Results: Group A had a substantially lower incidence of hypotension than Group B (p = 0.022). Patients in Group B had significantly lower systolic blood pressure values at the 6th, 8th, 10th, 12th, 14th, 15th, and 30th minutes of the surgery compared to Group A (p = 0.012, p = 0.014, p = 0.005, p = 0.016, p < 0,001, p = 0.002, and p = 0.011; respectively). Both groups had similar diastolic blood pressure and heart rate values during surgery (p > 0.05). The motor block resolving time and analgesia duration were longer in Group B compared to Group A (p < 0.001 for both). Two (5%) patients in Group A and ten (25%) patients in Group B experienced postoperative itching (p = 0.012). Conclusions: We concluded that combining 5 mg isobaric bupivacaine with 15 mcg of fentanyl administered intrathecally provides adequate anaesthesia while maintaining better hemodynamic stability in patients undergoing caesarean section.
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    Öğe
    Intraperitoneal instillation versus wound infiltration for postoperative pain relief after cesarean delivery: A prospective, randomized, double-blind, placebo-controlled trial
    (2022) Dağaşan Çetin, Gözdenur; Dostbil, Ayşenur; Aksoy, Mehmet; Kaşali, Kamber; İnce, Ramazan; Kahramanlar, Agah Abdullah; Atalay, Canan; Topdağı Yılmaz, Emsal Pınar; İnce, İlker; Özkal, Miraç Selcen
    Aim: To compare local anesthetic wound infiltration with intraperitoneal instillation of local anesthetic for analgesia after cesarean section under spinal anesthesia. Methods: This study was conducted on 150 pregnant women undergoing elective cesarean section under spinal anesthesia. Spinal anesthesia was performed with 7 mg isobaric bupivacaine and 15 μcg fentanyl. The patients were randomized into three groups of 50 patients each: Group local anesthetic wound infiltration (LWI): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was administered subcutaneous wound infiltration at the end of surgery prior to skin closure and 20 ml saline was instilled into the uterine peritoneal area before fascia closure. Group intraperitoneal local anesthetic (IPLA): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was instilled into the uterine peritoneal area and 20 ml saline was administered subcutaneous wound infiltration. Group Placebo: 20 ml saline was instilled into the uterine peritoneal area and 20 ml saline was administered local subcutaneous wound infiltration. Pain scores at rest and on movement, total fentanyl consumption at 24 h, maternal satisfaction, and the time to first analgesic request were recorded. Results: No statistically significant difference was observed in the postoperative pain scores at rest at 2, 12, and 24 h (p = 0.314, 0.343, and 0.735, respectively) and on movement at 12 and 24 h (p = 0.318 and 0.642, respectively) between the groups. The pain scores on movement at 2 h were significantly lower in Group IPLA compared with Group Placebo (p = 0.047). There were no significant differences between the groups in terms of total fentanyl consumption and the time to first analgesic request. Conclusion: The use of intraperitoneal instillation of bupivacaine and lidocaine reduces early the pain score on movement in women undergoing cesarean section under spinal anesthesia.