Table 3.11: Time -onset inhibition of the active M 0

Results onset motor inhibition of group I at M 0 is 2.60 ± 0.67 minutes, and group 2 was 2.83 ± 0.95 minutes, compared the results of this but no difference statistically significant, with p > 0.05.

Results inhibit onset MI campaign at roughly the same between the 2 study groups, the first group was 4.30 ± 0.88 minutes, and group II was 4.53 ± 0.94 minutes. Compare this result is not statistically significant, with p > 0.05.

Level of Group I

Time onset of the active inhibition of group II M I is 6.07 ± 0.98 minutes, and group II was 6.37 ± 0.89 minutes, a long time in group II than group I. However, this difference was not statistically significant with p > 0.05 .

Level of Group I

Time onset of the active inhibition of group I, III M: 7.67 ± 0.71 min, and a maximum of 9 minutes of the second group was 7.97 ± 0.72 minutes, maximum 10 minutes. This difference is not statistically significant, with p > 0.05 .

Recovery time campaigning totally at M0 group I was 165.56 ± 18.09 minutes and the second group was 156.11 ± 19.21 minutes, so the group II athletes recover faster than group I. However, this difference was not statistically significant, with p > 0.05.

Times (h)	Groupe I (n = 60)	Groupe II (n = 60)	p
­­ ± SD	23,23 ± 0,75	24,80 ± 1,09	<0,05
Min – max	21 – 26	23 – 28

Two research groups have used morphine 100mcg , the results are equivalent , postoperative analgesic time of group II was 24.80 ± 1.09 hours and the group I was 23.23 ± 0.75 hours. Compare this time in the 2 groups are different and there are statistically significant with p < 0.05 .

3.8.2.1. Changes in systolic blood pressure over time

3.8.2.2. Changes in diastolic blood pressure over time

3.8.2.3. Average blood pressure change over time

3.8.2.4. The rate of maternal hypotension

Table 3.28.Ty maternal hypotension rate

The rate of maternal hypotension is 11.67 % of group I, group II was 8.33 %. Comparison between the 2 groups did not differ much, however this result was not statistically significant , with p > 0.05.

In this study, the two groups of women fully awake.

The rate of nausea and vomiting than group I. Group II high But compare its middle 2 groups, the difference was not statistically significant, with p > 0.05 .

Side effects urinary retention in group II was 3.3 % and the group I was not any cases urinary retention after cesarean section . The difference in the two groups of this study was not statistically significant, with p > 0.05 .

Itching in group II ratio is 13.3% higher than in group I, in group I the result is 5%. This difference was not statistically significant, with p > 0.05.

Apgar scores of the 2 groups were higher than 97%, but the difference compare Apgar scores at each time point differences, the main difference between the two groups this is statistically significant, with p < 0.05.

In this study, no cases of fetal distress , however, only cord blood pH in infants 2 groups was similar and not statistically significant with p > 0.05 . The pO2 and pO2 values ​​have differences , though not much , but still statistically significant with p < 0.05.

According to the selection criteria and exclusion of this study, all the women were selected to study research is a normal pregnancy, the mother does not mean that there is any reason a patient and fetus as well as also completely normal. This ensures the maximum to avoid the effects of maternal disease, pathological condition of pregnancy to babies after birth , it is difficult to assess due to problems caused by anesthetics or anesthesia methods cause place.

4.2.1.1.Thoi onset pain killers:

Our results in Table 3.6 shows the onset of pain killers Group I and II, respectively: 2.23 ± 0.62 and 1.58 ± 0.56 minutes in the dominant T10; 3.83 ± 1.06 and 2.95 ± 0.57 minutes dominant at T6, 6.28 ± 1.39 and 4.68 ± 0.97 minutes at T4 dominant. Rapid onset of anesthesia time than in the group using sufentanil, about 1 minute more using fentanyl compared with controls, although this difference was not statistically significant with p > 0.05.

The findings of Nguyen Hoang Ngoc (fentanyl with bupivacaine coordinate): from 2 to 6 minutes.

The findings of Cardoso MM (in collaboration with bupivacaine morphine): from 2 to 5 minutes.

Time onset of pain killers in the dominant T10 sensory loss from the navel downwards, the first group average of 2.23 ± 0.62 minutes, while the antiseptic surgeon and surgical preparation is right. Also in group II, the faster this time, it was 1.58 ± 0.56 minutes. This result is consistent with studies of Jung Hyang Lee et al published in Korean J l.2011 February Anesthesie, 60 (2): 103-108. Comparison between the 2 groups differ, although only a very small difference of coordination sufentanil group but will work faster and statistically significant with p < 0.05.

Time inhibit pain sensation to T6 dominant memory loss feeling from the nose down, the two groups differ more clearly, which is in the group I have lost time waiting for the pain of 3.83 ± 1, 06 minutes, while in group II was 2.95 ± 0.57 minutes. With this level of analgesia will proceed faster surgery, group II about 2 minutes the operation was conducted smoothly, I group the operation can proceed more slowly, approximately 3 minutes. Cesarean section should better pain relief from inhibition T6.

Advantages of sufentanil fast and powerful effect than fentanyl, the results are consistent with studies of Nguyen Hoang Ngoc and Gunnar Dahlgren and the (Anesth Analg 1997; 85:1288-93).

Time to inhibit pain sensation T4 dominant from the nipple down, showed that in group I latency at T4 sensory loss is 6.28 ± 1.39 minutes, and group II was 4.68 ± 0.97 minutes. Obviously at this time group II than group I fast , this result was statistically significant with p < 0.05 and consistent with studies of Gunnar D et al.

According to the results of our study showed the combination with sufentanil 2mcg anesthetic in spinal anesthesia in caesarean sections, will make onset loss of feeling pain at T10, T6 earlier than when coordinated increase of 0.5% bupivacaine with fentanyl 20 mcg density. This may be due to the ability to quickly attach and affinity of sufentanil with μ receptor.

Thus, our results are similar to the results of NguyOn Hoμng Ngoc, Cardoso MM handcuffed prisoner with balance thereof with the results for BC sheets, Nguyen Van Minh, Abboud TK.

When combined with fentanyl or sufentanil to bupivacaine spinal anesthesia for cesarean delivery , induction period lasting sensory loss in the permitted level without affecting the operation and the time needed to get pregnant quickly, it this is needed in emergency surgery and especially fetal distress.

4.2.1.2.Thoi insensitive time:

The findings of Nguyen Hoang Ngoc: At T10 level is 177.3 ± 23.92 minutes; T6 is at 121.7 ± 22.44 minutes; T4 is at 85.6 ± 20.22 minutes.

Our results, in Table 3.10:

- At T10: groups I and II respectively: 175.03 ± 23.90 and 198.01 ± 20.07 minutes.

- At T6: groups I and II respectively: 121.15 ± 12.44 and 152.12 ± 15.02 minutes.

- At the T4 group I and II respectively: 115.1 ± 85.09 and 18.09 ± 20.26 minutes.

Thus, our results are similar to the results of Nguyen Hoang Ngoc. With such insensitivity on time, complete enough for the surgery.

Our results are similar to the G. Dahlgren study comparing the analgesic Full time between spinal anesthesia with bupivacaine and fentanyl 20mcg coordinate with the coordination team with 2.5 mcg sufentanil: Full Time analgesic sufentanil group longer than the fentanyl group (175.0 ± 53.7 versus 140 ± 34.4 minutes ) [Aneth article Analg 1997 Sweden]. Author N Vyas et al study comparing sufentanil with bupivacaine alone and bupivacaine in spinal anesthesia for cesarean section, published in the journal: J Anesthesiol Clin Pharmacol 2010, 26 : 488-92 result is time complete pain in the sufentanil group longer than the control group, there was statistically significant, the results of the study was 184.00 ± 107.00 ± 51.50 minutes and 40.40 minutes.

4.2.1.3.Muc of insensitivity for surgery

Here, quality refers to pain surgery Abouleizh Ezzat: 3 level is good, average and poor.

In this study no case less effective, pain relief methods to transfer . However, in group I still have 5 % (3/60) of patients had moderate effects, ie to more intra-operative analgesics and 1.7% in group II (1/ 60) of patients. Thus the quality of group II surgical pain and 98.3% reached 95.0% in group I patients. This result is similar to other authors as Dahlgren G, Jung Hyang Lee.

The findings of Nguyen Hoang Ngoc, Abboud TK, Cardoso MM, Katsuyki Terajima: 100 % good level.

Our study also results: over 98 % at good levels, so in theory only bupivacaine own making insensitive enough for surgery, in combination with morphine drug family, the quality of postoperative pain relief would be better.

4.2.2. Results inhibit movement

4.2.2.1.Thoi onset motor inhibition.

From the table 3:11, 3:12, 3:13, 3:14 in the study showed:

- At M0: group I average 2.60 ± 0.67 minutes, a maximum of 4 minutes. Group II average of 2.83 ± 0.95 minutes, a maximum of 6 minutes.

- At MI: group I average 4.30 ± 0.88 minutes, a maximum of 6 minutes. Group II average of 4.53 ± 0.94 minutes.

- At the M II: Group I average 6.07 ± 0.98 minutes, a maximum of 8 minutes. Group II average 6.37 ± 0.89 minutes, a maximum of 8 minutes.

At the third level of M: I team average of 7.67 ± 0.71 minutes, a maximum of 9 minutes. Group II average 7.97 ± 0.72 minutes, a maximum of 10 minutes.

The results showed differences in onset time inhibiting movement between the two groups at the same level near the same, just a difference of 1 minute .

The results of Nguyen Hoang Ngoc if bupivacaine with fentanyl coordination is 2.56 ± 0.73 at M0 , 6.33 ± 1.77 at 10.0 ± 2.92 in MI and M II level.

Duale study of C. showed that the soft body for good surgery.

Thus bupivacaine in combination with sufentanil to increase the proportion of spinal anesthesia for cesarean delivery, suggesting that inhibition onset satisfactory movement, creating good conditions for surgery of the soft body.

4.2.2.2.Thoi motor recovery time.

The length of time from onset hieenjlieetj fully mobilize until at M3 motor reappear.

From the 3:16, 3:17, 3:18, 3:19 we see: Recovery time campaigning to the M1 and M0 levels between the two groups, no difference was statistically significant, with p > 0.05 .

At Mo was 165.56 ± 18.09 minutes in group I and 156.11 ± 19.21 in group II.

The recovery time of athletes to the M1 group I was: 128.83 ± 20.03 and group II were: 127.83 ± 20.87 minutes.

The recovery time of athletes to the M2 group I was: 92.83 ± 14.78 and group II: 92.17 ± 15.63 minutes .

Our result is similar to findings of Nguyen Hoang Ngoc, Abouleish E , Milner AR, Uchiyama A.

Thus the recovery time campaigning in combination with bupivacaine with fentanyl or sufentanil is no different. However, the recovery time of athletes sufentanil group was 156.11 ± 19.21 minutes and shorter with fentanyl group was 165.56 ± 18.09 Results minutes, so soon after surgery patients can move about therapy departments. On the other hand when there is early mobilization will avoid closing lochia after the caesarean section, the obstetrician today after cesarean are advised patients to exercise and eat soon as possible.

4.2.3 . Postoperative analgesia

4.2.3.1.Thoi time for postoperative pain relief:

So far the author has a lot of research on postoperative pain relief, but the best method to reduce pain after cesarean delivery remains a difficult problem, because satisfaction with postoperative pain relief after surgery to go along with the athletic ability of mothers to care for infants. New techniques for postoperative pain control as intravenous drug use by PCA (patient - controlled analgesia) or by the epidural route PCEA (patient-controlled epidural analgesia), this technique expensive and limited the ability of the mother in the early newborn care, because affected by the sedative effects of opioids and motor blockade by regional anesthesia. Moreover, the drug through breast milk affects the baby for breastfeeding mothers.

Terajima Katsuyki spinal anesthesia study on 22 women with 200 mcg dose of morphine for postoperative pain relief results was 24 ± 0.2 hours.

Uchiyama A study on 80 women with 100mcg or 200 mcg dose of morphine results: time for postoperative pain relief lasted over 24 hours in both groups, but not the desired effect in the lower group 100mcg morphine group 200 mcg of morphine and the authors conclude: "100 mcg doses may be best for caesarean section". Similar to the results of CM Palmer, Dominique A. Coordinate research.

Abouleish E 200 mcg of morphine with bupivacaine spinal anesthesia for cesarean section 34 women, results showed that postoperative pain time average is 27 ± 0.7 hours, deem adverse effects on newborns after surgery. The author shows that it is effective and safe way to do insensitivity to pain after surgery and cesarean section.

Time for postoperative pain relief in the study of Tran Dinh Tu 24.31 ± 2.8 hours (with morphine dose 200 mcg), and the results of Nguyen Van Minh was 22.6 ± 3.1 hours.

In our study using morphine dose of 100 mcg for both groups, thereby resulting in reduced postoperative pain was similar.

The results of our study of postoperative analgesic time was: 24.80 ± 1.09 hours for group II, and 23.23 ± 0.75 for Group I. The difference between group II compared to group I are not statistically significant, with p > 0.05.

Thus, the combination of morphine 100mcg dose spinal anesthesia for cesarean section, the time for postoperative pain relief lasted an average of 24 hours, the results are consistent with other authors such as: Cade L, Dennis AR, Ginosar Y. noted. Time analgesics such help bring peace of mind, comfort and spiritual excited about being active women and infant care.

- Group I: high proportion of bupivacaine 0.5% with 7.5 mg morphine fentanyl 20 mcg and 100 mcg .

- Group II: high proportion of 0.5% bupivacaine 7.5 mg morphine with sufentanil 2 mcg and 100 mcg.

I have obtained the following results:

- The team has used sufentanil onset pain killers and 1.58 ± 0.56 minutes shorter than the fentanyl group was 2.23 ± 0.62 Results minutes. According to this study, after spinal anesthesia for 2 minutes to start the operation.

- Time insensitivity in studies using sufentanil group was 198 ± 20.07 minutes and lasts longer than using fentanyl group results is 175.03 ± 23.09 minutes. With time so is insensitive enough for a normal cesarean section.

- Time for postoperative pain relief in sufentanil group was 24.80 ± 1.09 minutes and lasting than the fentanyl group was 23.23 ± 0.75 Results minutes, this result was statistically significant with p < 0.05.

- Advocacy and the body in soft surgery: onset inhibition of sufentanil group was 2.83 ± 0.95 minutes is equivalent to fentanyl group was 2.60 ± 0.67 minutes and the total time time inhibition of movement and muscle relaxation group was 156.11 ± 19.21 minutes sufentanil and fentanyl group was 165.56 ± 18.09 minutes, postoperative recovery group movement faster sufentanil fentanyl group favorable for the operation and postoperative recovery.

2. Unwanted Effects

2.1.Tren women:

- The rate of hypotension using sufentanil group is 8.33% lower than the fentanyl group was 11.67%, however comparisons between 2 groups was not statistically significant. So 2mcg sufentanil used in this study is appropriate.

Heart rate: sufentanil group reported a reduction in heart rate than fentanyl group.

Respiratory: respiratory rate of 2 results the team is from 20 to about 24 times/min, in normal limits. Results oxygen saturation of 99% on the 2 groups were no cases of respiratory distress.

Nausea - vomiting during and after surgery using sufentanil group was 11.7% higher than the fentanyl group was 3.3%.

Urinary retention sufentanil group only at the rate of 3.3% and fentanyl group does not meet the case.

Itching in the sufentanil group rate is 13.3% higher than the fentanyl group rate is 5.0% and not require treatment.

2.2.Tren infant:

- Results of the Apgar score used sufentanil group and fentanyl group were reached on 8 points in the first and fifth minutes, all in the normal range.

- Results of umbilical arterial blood gases 2 groups of infants were within the normal range, there is no difference.
PROPOSALS
1 . Research using sufentanil in spinal anesthesia with doses to find the best dose for cesarean section.

2 . Research methods of prophylaxis and treatment of nausea, pruritus after cesarean delivery and had spinal anesthesia. This study is appropriate.

1. Nguyen The Loc, Phan Dinh Ky (2010), "Research collaboration with Sufentanil bupivacaine epidural anesthesia for pain relief during birth at the Central Obstetrics Hospital from January 07-09/2009", Journal of Health Information pharmaceutical, No. 05. pp. 36.

2. Nguyen The Loc, Phan Dinh Ky (2010), "Research collaboration with Morphine bupivacaine (Opiphin) or Sufentanil in spinal anesthesia for surgery and pain relief after Caesarean section", Journal of Medical Information, No. 08, pp. 23.

3. Nguyen The Loc, Phan Dinh Ky (2010), "Assessment of pain relief during labor for at BVPSTW (7/2009-10/2010)", Practical Journal of Medicine, No. 744, pp.126.