ISPUB.COM The Internet Journal of Anesthesiology Volume 31 Number 1 1 of 7 Comparative Evaluation Of Low Dose Hyperbaric Bupivacaine With Or Without Fentanyl In Spinal Anaesthesia For Caesarean Section In Patients With Pregnancy Induced Hypertension F Sheikh, M Ahmed, M Ommid, S Gurcoo, N Shakoor, S Nazir, G Nisa Citation F Sheikh, M Ahmed, M Ommid, S Gurcoo, N Shakoor, S Nazir, G Nisa. Comparative Evaluation Of Low Dose Hyperbaric Bupivacaine With Or Without Fentanyl In Spinal Anaesthesia For Caesarean Section In Patients With Pregnancy Induced Hypertension. The Internet Journal of Anesthesiology. 2013 Volume 31 Number 1. Abstract Neuraxial administration of opioid’s along with local anesthetics improve the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration. The present study was conducted to study and compare the effects of bupivacaine alone and its combination with fentanyl used intrathecally in parturients with PIH. 50 ASA grade II patients with PIH defined as blood pressure between 140-160/ 90-110 mmHg without proteinuria were selected and divided into 2 groups as Group (I)-Bupivacaine and Group (II)- Bupivacaine- Fentanyl group. Haemodynamic variables like systolic and diastolic blood pressure, heart rate were recorded every 2 minutes upto delivery of baby and then every 5 minutes until end of surgery. Sensory block and motor block alongwith side effects were recorded. Pain was evaluated using visual analogue scale and neonatal outcome assessed using APGAR scoring. The highest sensory level achieved in bupivacaine-fentanyl group was higher than in the group receiving plain bupivacaine. The time taken for sensory regression to T12 and duration of analgesia was longer in the Bupivacaine-Fentanyl group. We conclude the combination group prolongs the duration of sensory spinal block, increases the duration of analgesia without increasing the duration of motor block, does not cause any significant side effects and provides stable haemodynamic conditions without fetal or maternal compromise. INTRODUCTION Spinal anaesthesia has been widely used for caesarean section in normal as well as preeclamptic parturients and has been found to be efficacious and safe. 1234 After the discovery of opioid receptors in spinal cord and direct opioid action at this level, possibility of synergism between opioids and local anaesthetics , , co administered intrathecally has been explored extensively in obstetric population undergoing caesarean delivery 5. Although hypotension due to decrease in systemic vascular resistance resulting from the blockade of preganglionic sympathetic fibres 6 remains a problem with all central neuraxial blocks; the synergistic action of local anaesthetics with opioid can be of great benefit in achieving adequate anaesthesia with lesser dose of local anaesthetics, thereby reducing chances and severity of hypotension. Neuraxial administration of opioids along with local anaesthetics improves the quality of intra-operative analgesia and also provides postoperative pain relief for longer duration 7 Opioids and local anaesthetics administered together intrathecally have a potent synergistic analgesic effect Improving the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration ,8,9 Bupivacaine was the first local anaesthetic that produced adequate pain relief, without a major effect on motor fibers 10 Fentanyl is one of the most extensively used opioids for this purpose and has been found to be safe and effective both in terms of neonatal and maternal outcome not only in normal parturients but also in severely preeclamptic patients for labour analgesia and elective caesarean section 11,12 Considering the above facts, we designed the present study using low dose bupivacaine with low dose fentanyl to assess the hemodynamic stability, perioperative analgesia and neonatal outcome in pregnancy induced hypertensive patients. MATERIAL AND METHODS 50 ASA Grade II patients with pregnancy induced hypertension scheduled for elective lower segment caesarean