Effects of Spinal Anesthesia with Low-Dose of Lidocaine plus Fentanyl on Maternal Hemodynamic State in Severe Pre-eclamptic Patients Undergoing Cesarean Section

Introduction: The hypotension following spinal anesthesia remains common place in cesarean delivery. Sympathetic blockade effects are more intense in preeclamptic parturients and these patients need more ephedrine after spinal block. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The aim of this study was to evaluate maternal hemodynamic stability, following spinal anesthesia with lowdose of lidocaine plus fentanyl severe pre-eclamptic parturients undergoing in cesarean section. Materials and Methods: This clinical trial study was performed from 2005 to 2006 on patients at Al-Zahra Hospital of Tabriz University of Medical Sciences. A total of 60 patients with severe preeclampsia divided into two groups of case and control randomly. Thirty patients received 50mg lidocaine with 10µg fentanyl (study group), and in the other 30 patients 100mg lidocaine (control group) was used during spinal anesthesia. Heart rate and blood pressure were recorded at regular intervals. Pain, discomfort, nausea, and vomiting during surgery were observed. Neonatal Apgar score was assessed at 1 and 5 min after delivery. All data were recorded in a questionnaire and analyzed by descriptive statistics, Fisher, Ki Square and T-Tests. Results: Patients of the study group had a less frequent incidence of clinically significant hypotension (20 vs 63.33 of patients respectively; p<0.0001). The magnitude of the decrease in blood pressure was significantly larger in the control patients than the study group (34.6±10.3 percent vs 23.5±8.4 percent respectively; p<0.0001). Ephedrine requirements due to hypotension were more in the control group than in the study group (4.0±5.15 mg vs 1.33±2.60 mg respectively; p=0.015). The incidence in heart rate changes, higher than 30 was also similar between the groups. However, the incidence in heart rate was larger magnitude in the control group (p=0.19). Pain and discomfort during surgery were experienced more frequently in the control group (83.33) than in study group (16.66). Neonatal 1-and 5-min Apgar scores were also similar in two groups (p=0.75, p=0.22 respectively). Conclusion: Intrathecal low-dose of lidocaine with fentanyl provides a good surgical anesthesia with hemodynamic stability, without neonatal compromise in severe preeclamptic patients undergoing cesarean section