Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Oct-Dec;13(4):340-351.
doi: 10.4103/sja.SJA_17_19.

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

Semagn Mekonnen Abate  1 , Akine Eshete Belihu  2
Affiliations
Review

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis

Semagn Mekonnen Abate et al. Saudi J Anaesth. 2019 Oct-Dec.

Abstract

Hypotension during spinal Anesthesia is the most common complication with maternal and neonatal morbidity and mortality. Low dose bupivacaine with intrathecal fentanyl is recommended as strategy to prevent spinal Anesthesia induced hypotension and related complications. The aim of this systemic review is to evaluate the efficacy of low dose bupivacaine with Intrathecal fentanyl on the improvement of maternal and neonatal outcomes compared to conventional dose bupivacaine among mothers who undergone cesarean section. We conducted a systemic search of the electronic databases of Pubmed, Medline, LILACS and others with PICO strategy for randomized controlled clinical trials comparing low dose bupivacaine with fentanyl and conventional dose bupivacaine for cesarean section. Joanna Briggs Institute (JBI) standardized data extraction form was used for data extraction and finally entered into Review Manager for data synthesis. Ten Randomized trials (552) were included in this review. Incidence of hypotension was less likely in mothers who received low dose bupivacaine with Fentanyl as compared to those with conventional dose of bupivacaine alone (RR = 0.43, 95% confidence interval (CI) 0.12-0.47, ten trials, 552 participants). The review revealed that Low dose bupivacaine combined with intrathecal Fentanyl decrease incidence of hypotension.

Keywords: Bupivacaine; cesarean section; hypotension; spinal Anesthesia.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram
Figure 2
Figure 2
Forest plot for incidence of hypotension low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis. Events: the total numbers with the events. Total: the total number of participants in intervention and control. Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. M–H, Mantel–Haenszel methods
Figure 3
Figure 3
Forest plot for mean intraoperative systolic blood pressure comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 4
Figure 4
Forest plot for mean intraoperative diastolic blood pressure comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 5
Figure 5
Forest plot for incidence of nausea/vomiting comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis. Events, the total numbers with the events total: the total number of participants in intervention (SA) and control (GA). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. M–H, Mantel–Haenszel methods
Figure 6
Figure 6
Forest plot for time to sensory block comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis. Total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 7
Figure 7
Forest plot for time to two segment regression comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis. Total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 8
Figure 8
Forest plot for complete sensory recovery comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 9
Figure 9
Forest plot for complete motor recovery comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis total: the total number of participants in intervention (BF) and control (B). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. IR: Inverse Variance
Figure 10
Figure 10
Forest plot for Incidence of adverse effects comparing low dose bupivacaine-fentanyl vs bupivacaine alone: individual trials and meta-analysis. Events, the total numbers with the events total: the total number of participants in intervention (SA) and control (GA). Weight: sample size contribution of the study relative to the pooled sample size of the meta-analysis. M–H, Mantel–Haenszel methods
See this image and copyright information in PMC

References

    1. Ahmed NU, Khan MI, Khan AI, Akhtaruzzaman A. Low dose bupivacaine plus fentanyl in subarachnoid block for caesarean section. Delta Med Coll J. 2016;4:24–30.
    1. Venkata H, Porika S, Talari G, Pasupuleti S, Pabba U. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi J Anaesth. 2015;9:122. - PMC - PubMed
    1. Kumar M, Gajbhare N, Kamble NP. Comparative study of intrathecal bupivacaine versus bupivacaine with fentanyl for cesarean section. Indian J Clin Anesth. 2016;3:271–7.
    1. Sivevski A. Spinal anaesthesia for cesarean section with reduced dose of intrathecal bupivacaine plus fentanyl. Biol Med Sci. 2006;27:225–36. - PubMed
    1. Seyedhejazi M, Madarek E. The effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section. Pakistan J Med Sci. 2007;23:747–50.