HAEMODYNAMIC PRESERVATION IN CESAREAN SECTIONS BY LOW DOSE 0.5% HYPERBARIC BUPIVACAINE

Authors

  • Maqsood Ahmad
  • Mumtaz Ahmad
  • Naveel Atif

Abstract

Background: Spinal anaesthesia is technique of choice for caesarean sections and hyperbaric bupivacaine is a recommended drug for this popular block. Although safe but few complications are haemodynamic changes, postdural puncture headache, cauda equina syndrome and radiculopathy. However, hypotension remains the common side effect which is believed to occur in 95% of patients resulting in reduction of uteroplacental perfusion causing foetal acid-base abnormalities. Various doses regimes are in safe anaesthesia practice for providing regional anaesthesia for such patients with least detrimental effects on foetal outcome. This study was carried out to find the effective dose of 0.5 % hyperbaric bupivacaine in caesarean section patients by comparing two different doses. Methods: After enrolling two hundred patients of C section (Caesarean section) for this study, 90 patients were selected to compare the effects of 0.5% hyperbaric bupivacaine. Group A (n=45) received 10 mg of drug while group B (n=45) received 12 mg for spinal anaesthesia. Onset of block, sensory and motor level, haemodynamic changes, surgery time, maternal satisfaction, APGAR score and incidence of complications were compared in two groups. Results: Blood pressure decreases were less in Group A (p-0.074) but not statistically significant. Phenylephrine for hypotension was given to 17% vs 5% in group B. Maternal satisfaction was found to be better in group B 33 vs 17 but was statistically significant (p 0.034). 2% patients had bradycardia in group A which was treated by atropine. No complications were reported in either group. Conclusion: Doses of hyperbaric bupivacaine for spinal anaesthesia in caesarean sections must be at least 12 mg because it produces excellent anaesthesia and maternal satisfaction without complications.Keywords: hyperbaric bupivacaine 0.5 %; spinal anaesthesia; C-section; Bupivacaine; Haemodynamic

References

Islam MS, Nahar S, Huq SS. Effecacy of low dose hyperbaric bupivacaine in spinal anaesthesia for LUCS. Bangladesh Med J Khulna 2012;45(1-2):15–8.

Hyderally H. Complicatios of spinal Anesthesia. Mt Sinai J Med 2002;69(1-2):55–6.

Clinics for Anesthesia, Reanimation and Intensive Care(CARIL)/Department of Gynecology and Obstetrics, Clinical Center, Medical Faculty. Ss. Cyril and Methodius University, Skopje, R. Macedonia Sec. Bio Med Sci xxv11/2(2006) 225-236.

NYSORA - The New York School of Regional Anesthesia-Spinal anaesthesia, [Internet]. [cited 2014 Nov 10]. Available from: www.nysora.com/regional_anesthesia/.../3119- spinal_anesthesia.html

Bernal Carcia J, Gallego Garcia J, Abengochea Containa A. Hyberbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia. Rev Esp Anesteriol Reanim 2007;54(1):4–10.

Guasch E, Suarez A, Bermejo JM, Gilsanz F. Randomized controlled trial comparing a low dose to a conventional dose of hyperbaric bupivacaine for scheduled cesarean section. Rev Esp Anestesiol Reanim 2005;52(2):75–80.

Mebaaza MS, Qureshi S, Ben Meflah 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 dose blood pressure episodes. Middle East J Anesthediol 2010;20(5):673–8.

Keith G. Aliman, Lain H. Wilson, Aidan O’Donnell. Oxford handbook of Anaesthesia 3rd edition 22;756-758.

Reves M, Pan PH. Very low-dose spinal anesthesia for cesarean section in a morbidly obese preelamptic patient and its potential implications. Int J Obstet Anesth 2004;13(2)99–102.

Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delvery: systemic review and meta-analysis. Br J Anaesth 2011;107(3):308–18.

Bernat Garcia J, Gallego Garcia J, Abengochea Containa A. Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia. Rev Esp Anestesiol Reanim 2007;54(1):4–10.

Guasch E, Suarez A, Bermejo JM, Gilsanz E. Randomized controlled trial comparing a low dose to conventional dose of hyperbaric bupivacaine for scheduled cesarean section. Rev Esp Anestesiol Reanim 2005;54(2):75–80.

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):1600–5.

Karaca F, Erkılıç E, Akdıkan A, Gümüş T, Kanbak O. Assessment of the Effect of Intrathecal Low Dose Levobupivacaine or Bupivacaine Combined with Fentanyl in Patients Undergoing Cesarean Section. J Anesth Clin Res 2014;5(11):465.

Sen S, Osmert G, Aydin ON, Baran N, Caliskan E. The persisting analgesic effect of low-dose intravenous ketamine after spinal anaesthesia for cesarean section. Eur J Anaesthesiol 2005;22(7):518–23.

Targ WX, Li JJ, Bu HM, Fu ZJ. Spinal anaesthesia with low-dose bupivacaine in marginally hyperbaric solutions for caesarean section: A randomized controlled trial. Eur J Anaesthesiol 2014;32(7):493–8.

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 Aanesthesiol 2010;20(5):673–8.

Downloads

Published

2017-04-08