KASMEJ
Kastamonu Medical Journal

Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

eISSN: 2757-9336
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Comparison of the efficacy of two different doses of low-dose bupivacaine for spinal anesthesia in patients undergoing cesarean operations on anesthesia quality and intraoperative hemodynamic parameters
Abstract
Aims: The primary aim of this study was to investigate the effects of two different low-dose bupivacaine used in cesarean operations on intraoperative hemodynamic parameters, and the secondary aim was to evaluate the time of anesthesia onset, motor block scores, and the need for vasopressor agent.
Methods: This prospective randomized double-blind study was performed on 72 pregnant women who underwent cesarean surgery. We randomized the patients into two groups, Group A and Group B, and performed a combined spino-epidural anesthesia. Group A received a solution containing 5 mg isobaric bupivacaine+15µg fentanyl+0.5 isotonic (total volume 1.8 ml) and Group B received a solution containing 7.5 mg bupivacaine+15µg fentanyl (total volume 1.8 ml) over a period of 30 seconds. Vital signs were recorded before the spinal anesthesia and perioperatively. Demographic data, hemodynamic parameters, vital signs and side effects, operation duration, time interval from spinal injection to placement in the supine position, Apgar scores, time interval from spinal injection to delivery, analgesia duration, the degree of motor block immediately before the surgery and at the end of the operation, maximum block level, time for sensory block to reach T6 dermatome level after spinal injection and postoperative side effects were recorded. We recorded the postoperative time to resolution of motor block and the time to regression of sensory block to T10.
Results: There was no statistically significant difference between the two groups in terms of demographic data, anesthesia duration, surgery duration, time interval from spinal injection to placement in the supine position, time interval from spinal injection to delivery, analgesia duration, time for sensory block to reach T10, T6, and T4 dermatomes, 1- and 5-minute (min) Apgar scores, and preoperative Bromage scores. While the mean time to resolution of motor block was 159.69±65.72 min in Group B, the mean time to resolution of motor block was 123.13±64.93 min in Group A and the difference was statistically significant (p=0.02). Hypotension was observed in 19 patients (52.77%) in Group A and 29 patients (80.55%) in Group B (p=0.012). A statistically significant difference was detected between the two groups in terms of the need for vasopressor agent and the amount of ephedrine used (p=0.012, p=0.021, respectively). Postoperative Bromage score was 1.25±0.93 in Group A while it was 2.47±1.27 in Group B (p=0.000).
Conclusion: In patients undergoing CS, we found that intrathecal administration of 5 mg isobaric bupivacaine combined with 15 mcg fentanyl and 0.5 ml isotonic not only provided adequate anesthesia but also better preserved hemodynamic stability and significantly shortened the time to resolution of motor block. We believe that this dose can be used safely in patients undergoing CS. Further studies using varying intrathecal bupivacaine doses are necessary to validate our findings.

Keywords : Cesarean, spinal anesthesia, low-dose bupivacaine, hemodynamics

Download Article


1. Dourado AD, Lins Filho RLdM, Fernandes RAML, Gondim MCdS, Nogueira EVM. Associação de sufentanil a dose reduzida de bupivacaína hiperbárica em raquianestesia para cesariana: ensaio clínico randomizado. Rev Bras Anestesiol. 2016;66(6):622-627.
2. Golfam P, Yari M, Bakhtiyari HR. Minimum appropriate dose of lidocaine with a fixed dose of sufentanil epinephrine used for spinal anesthesia in caesarian section. Anesth Pain Med. 2013;2(3):123-126. doi:10.5812/aapm.7810
3. Qiu MT, Lin FQ, Fu SK, et al. Combination of low-dose bupivacaine and opioids provides satisfactory analgesia with less intraoperative hypotension for spinal anesthesia in cesarean section. CNS Neurosci Ther. 2012;18(5):426-432. doi:10.1111/j.1755-5949.2012.00306.x
4. De-Giorgio F, Grassi VM, Vetrugno G, d’Aloja E, Pascali VL, Arena V. Supine hypotensive syndrome as the probable cause of both maternal and fetal death. J Forensic Sci. Nov 2012;57(6):1646-1649. doi:10.1111/j.1556-4029.2012.02165.x
5. Wang LZ, Zhang YF, Hu XX, Chang XY. A randomized comparison of onset of anesthesia between spinal bupivacaine 5 mg with immediate epidural 2% lidocaine 5 ml and bupivacaine 10 mg for cesarean delivery. Int J Obstet Anesth. 2014;23(1):40-44. doi:10.1016/j.ijoa.2013.08.009
6. Weigl W, Bierylo A, Wielgus M, et al. Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section: a randomized controlled study. Medicine. 2016;95(24):e3827. doi:10.1097/md.0000000000003827
7. Heesen M, Weibel S, Klimek M, Rossaint R, Arends LR, Kranke P. Effects of epidural volume extension by saline injection on the efficacy and safety of intrathecal local anaesthetics: systematic review with meta-analysis, meta-regression and trial sequential analysis. Anaesthesia. 2017;72(11):1398-1411. doi:10.1111/anae.14033
8. Carvalho B, Collins J, Drover DR, Atkinson Ralls L, Riley ET. ED(50) and ED(95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology. 2011;114(3):529-535. doi:10.1097/ALN. 0b013e318209a92d
9. Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25(3):240-245. doi:10.1016/s1098-7339(00)90005-1
10. Kang FC, Tsai YC, Chang PJ, Chen TY. Subarachnoid fentanyl with diluted small-dose bupivacaine for cesarean section delivery. Acta anaesthesiologica Sinica. 1998;36(4):207-214.
11. Ben-David B, Miller G, Gavriel R, Gurevitch A. Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery. Reg Anesth Pain Med. 2000;25(3):235-239.
12. Roofthooft E, Van de Velde M. Low-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2008;21(3):259-262. doi:10.1097/ACO.0b013e3282ff5e41
13. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia. 2005;60(7):636-653. doi:10.1111/j.1365-2044.2005.04223.x
14. Chandra S, Nugroho AM, Agus H, Susilo AP. How low can we go? A double-blinded randomized controlled trial to compare bupivacaine 5 mg and bupivacaine 7.5 mg for spinal anesthesia in cesarean delivery in indonesian population. Anesth Pain Med. 2019;9(2):e91275. doi:10.5812/aapm.91275
15. Vaida S, Dalal P, Mets B. Spinal anesthesia for Cesarean delivery following pre-existing epidural labour analgesia. Can J Anaesth. 2009;56(12):988-989. doi:10.1007/s12630-009-9215-6
16. Kimoto M, Murao K, Shirane A, et al. Appropriate dose of isobaric bupivacaine with fentanyl in spinal anesthesia for cesarean section. Masui Japanese J Anesth. 2005;54(8):864-868.
17. Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005;14(3):230-241. doi:10.1016/j.ijoa.2004.12.004
18. Van De Velde M. Spinal anesthesia in the obstetric patient: prevention and treatment of hypotension. Acta Anaesthesiol Belg. 2006;57(4):383-386.
19. Lee JH, Chung KH, Lee JY, et al. Comparison of fentanyl and sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol. 2011;60(2):103-108. doi:10.4097/kjae.2011.60.2.103
20. Mebazaa MS, Ouerghi S, Ben Meftah R, Ben Cheikh M, Mestiri T, Ben Ammar MS. Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes. Middle East J Anaesthesiol. 2010;20(5):673-678.
21. Ahmed NU, Khan MI, Khan AI, Akhtaruzzaman A. Low dose bupivacaine plus fentanyl in subarachnoid block for caesarean section. Delta Med College J. 2016;4(1):24-30.
22. Zhang N, He L, Ni JX. Level of sensory block after spinal anesthesia as a predictor of hypotension in parturient. Medicine. 2017;96(25):e7184. doi:10.1097/md.0000000000007184
23. Turhanoglu S, Kaya S, Erdogan H. Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section? J Anesth. 2009;23(3):353-357. doi:10.1007/s00540-009-0750-7
24. Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anaesth. 2007;54(7):531-537. doi:10.1007/bf03022316
25. Kiran S, Singal NK. A comparative study of three different doses of 0.5% hyperbaric bupivacaine for spinal anaesthesia in elective caesarean section. Int J Obstet Anesth. 2002;11(3):185-189. doi:10.1054/ijoa.2002.0949
26. Leo S, Sng BL, Lim Y, Sia AT. A randomized comparison of low doses of hyperbaric bupivacaine in combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg. 2009;109(5):1600-1605. doi:10.1213/ANE.0b013e3181b72d35
27. Akbayram S, Dogan M, Ustyol L, et al. The clinical outcome of 260 pediatric ITP patients in one center. Clin Appl Thromb Hemost. 2011;17(6):E30-E35. doi:10.1177/1076029610379849
Article available in :
Volume 4, Issue 3, 2024
Page : 96-101
https://doi.org/10.51271/KMJ-0151
Article Information
Received : 29 May 2024
Accepted : 01 Tem 2024
Published : 01 Eyl 2024
Corresponding Author :

Ömer Doymuş: Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum Turkiye

[email protected]
Citation : Doymuş Ö, Dostbil A, Aksoy M, İnce İ, Cimilli Şenocak G. Comparison of the efficacy of two different doses of low-dose bupivacaine for spinal anesthesia in patients undergoing cesarean operations on anesthesia quality and intraoperative hemodynamic parameters. Kastamonu Med J. 2024;4(3):96-101.

Read: 296
Cited: 0
Download : 208
_Footer