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Prospective study of low dose hyperbaric bupivacaine for elective cesarean section
Abstract Number: 19
Abstract Type: Original Research
Prospective study of low dose hyperbaric bupivacaine for elective cesarean section.
PURPOSE: Maternal hypotension is a common complication of spinal anesthesia with bupivacaine (10-12 mg) for cesarean section (CS). It has been suggested that low dose bupivacaine combined with fentanyl may decrease hypotension. The objective of this study was to determine if such a combination provides effective anesthesia in our patient population. Secondary objectives were to determine if this combination is associated with less hypotension, vasopressor use, bradycardia, and nausea.
METHODS: The study was carried out in an academic tertiary care obstetric hospital. After Research Ethics Committee approval and informed consent, 39 consecutive parturients with singleton pregnancies scheduled for elective CS were enrolled in this study. All patients received hyperbaric bupivacaine 5mg with fentanyl 20 mcg and morphine 100 mcg intrathecally. Sensory and motor blocks and maternal hemodynamics were measured at regular intervals. Use of vasopressor and supplemental analgesics and anesthesia, and side effects were noted.
RESULTS: The incidence of sensory block ≥ T6 at 5 and 10 min were 95% and 98%. Bromage score of 0 at end of surgery was found in 52% of patients and in 97% of patients at 30 min later. Side effects were present in 25% of patients (hypotension 10%, vasopressor use 5%, bradycardia 5%, and nausea 5%). Supplementation of anesthesia was carried out in 15% of patients. However, no patient was converted to GA.
CONCLUSION: Low dose intrathecal bupivacaine, 5 mg with fentanyl, 20 mcg and morphine, 100 mcg was feasible for CS in our patient population. This combination of local anesthetic and narcotics was associated with decreased hypotension. These results need to be confirmed in a randomized clinical trial.