Intrathecal Hyperbaric Bupivacaine with Varying Doses of Buprenorphine for Postoperative Analgesia after Cesarean Section: A Comparative Study

BACKGROUND: Postoperative analgesia after cesarean section poses unique clinical challenges to anesthesiologist. Intrathecal buprenorphine is a promising drug for postoperative analgesia. AIM: The aim of this study was to compare the efficacy of two doses of buprenorphine (45 μg and 60 μg) as an adjuvant to hyperbaric bupivacaine for postoperative analgesia in cesarean section. SETTING AND DESIGN: Prospective randomized double-blind controlled study involving ninety parturients posted for elective cesarean section under subarachnoid block. MATERIALS AND METHODS: Group A (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 45 μg buprenorphine, Group B (n = 30) received 1.8 ml 0.5% hyperbaric bupivacaine with 60 μg buprenorphine, Group C (n = 30) received 1.8 ml of 0.5% hyperbaric bupivacaine with 0.2 ml normal saline, respectively. Following parameters were observed: onset and duration of sensory block, postoperative pain scores based on visual analog scale (VAS), rescue analgesic requirement, and maternal and neonatal side effects if any. STATISTICAL ANALYSIS: Unpaired t-test and Chi-square test were used. RESULTS: Duration of postoperative analgesia was significantly prolonged in Groups A and B in comparison to Group C and it was longest in Group B. Rescue analgesic requirement and VAS score were significantly lower in the buprenorphine groups. No major side effects were observed. CONCLUSION: Addition of buprenorphine to intrathecal bupivacaine prolonged the duration and quality of postoperative analgesia after cesarean section. Increasing the dose of buprenorphine from 45 μg to 60 μg provided longer duration of analgesia without increase in adverse effects.