Comparing the Conventional with Low Dose of Bupivacaine Plus Fentanyl in Spinal Anesthesia on the Neonate Apgar Score in Yazd City Running Title: Bupivacaine Plus Fentanyl in Spinal Anesthesia

Introduction: Spinal anesthesia is the preferred method of anesthesia in cesarean section, due to less complications. The augmentation of opioids to spinal anesthetics can improve the quality and increase the duration of analgesia. This study aimed to compare the conventional with low dose of bupivacaine plus fentanyl in spinal anesthesia on the neonate Apgar score in elective cesarean section. Methods: The present double-blind randomized clinical trial was conducted on 150 pregnant mothers undergoing cesarean section with the spinal anesthesia during 2017-2018. The mothers were randomly assigned to two groups of 75. The spinal anesthesia was performed in the first group with the injection of 15 mg of 0.5% hyperbaric bupivacaine plus 1 ml of normal saline, and in the second group with the injection of 12.5 mg of 0.5% hyperbaric bupivacaine plus 25 μg of fentanyl. For both groups, 1and 5-minute neonatal Apgar scores were assessed. Finally, the data were analyzed by SPSS17 software using statistical tests. Results: The mean age of the samples was 30.1±5.19 years with a range of 18-42 years (P-value=0.246). The mean gestational age was 38 weeks, the mean 1-minute Apgar score was 8.88 and the mean 5-minute Apgar score was 9.89 Conclusion: With the augmentation of fentanyl to bupivacaine for spinal anesthesia, the conventional dose can be reduced, which not only reduces the common side effects of Marcainee, but also provides an appropriate level of anesthesia and does not affect the neonatal Apgar score. INTRODUCTION The cesarean section is a common termination of pregnancy that is expanding with the advancement of medical knowledge. With electronic fetal monitoring, cesarean section is used today for birth at older ages and in breech birth. In the cesarean section, the spinal anesthesia is a conventional anesthetic method, and it seems more appropriate than general anesthesia as it facilitates the relationship between mother and baby and the onset of early infant feeding (1). The spinal anesthesia is a subcategory of regional anesthesia, performed by injection of a local anesthetic solution in the subarachnoid space (intrathecal) (2). The specific sensory block level is applied in each surgery, depending on the process. For example, T4-T6 levels (spinal cord 4 to 6) are appropriate for cesarean section. Upper sensory block level causes hypotension. Hypotension, need for ephedrine and nausea are some of the complications that occur when using high doses of spinal anesthetics, such as bupivacaine, hereby resulting in longer recovery time (3). Anesthesiologists face a variety of complications for cesarean section, most notably the side effects of using anesthetics on the fetus. The anesthetics after crossing the placenta, have various effects, such as weakening of the central nervous system (CNS) and respiratory distress on the fetus. Each of these complications can cause other abnormalities and ultimately death of the baby (4). Given the complications noted, attempts have been made to exclude, as far as possible, debilitating CNS drugs such as narcotics or benzodiazepines for cesarean section. However, failure to prescribe these medications may also have other serious consequences for the mother (5). For this reason, today it has been tried to minimize the risk of harmful birth of healthy babies by producing new drugs with short half-life, even for several minutes in some cases. Moreover, the mother will experience a painless delivery (6). Therefore, the use of intrathecal drugs along with local anesthetics and its effect has been evaluating on the level of anesthesia and analgesia and the duration of anesthesia. The use of narcotics combined with local anesthetics in the spinal anesthesia increases the duration of anesthesia, enhances the severity of anesthesia and analgesia, ARTICLE INFO Article history Received: Aug 06, 2020 Accepted: Aug 08, 2020 Published: Aug 25, 2020 Volume: 5 Issue: 2