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CAN WE GET MATERNAL HYPOTENSION “0” with LOW DOSE USING A COMBINED SPINAL-EPIDURAL TECHNIQUE? A randomized controlled trial
Abstract Number: F 29
Abstract Type: Original Research
Background: We investigated the possibility of reducing the hypotensive events that can occur during a caesarean delivery by combining a spinal epidural technique, using low or ultra-low drug dose.
Method: One hundred and two women scheduled for elective caesarean delivery, were randomly chosen to receive either intrathecal hyperbaric l-bupivacaine 3.75mg (L-3.75 n=51) in addition to fentanyl18µg or hyperbaric l-bupivacaine 5mg (L-5, n=51) in addition to fentanyl 25µg. In both group 10ml of l-bupivacaine isobaric 0.25% was administrated epidurally. The following parameters were used: Hemodynamic data, vasoactive drugs, pH fetal and neonatal resuscitation rate as well as sensor motor levels at 3,5,10 minutes and the end of the surgery.
Results: The demographic characteristics, the baseline hemodynamic profiles, the length of surgery and the caesarean’s reasons were similar in both groups. The previous abdominal surgery was taken into account because of the possible fibrous and adherences. And this was homogeneous as well.
There were no differences in the incidence of hypotension vasoactive drugs between the two groups, although it was less in L-3.75 group. The global hypotension incidence was 32.35%. The motor block was lower in L-3.75 group. The Bromage scale was 0 in 84.3% and 3 in 5.9% in L-3.75 group at the end of the surgery, and Bromage 0 of 52.9% either Bromage 3 in 9.85 in L-5 group. The sensory block achieved was enough for a caesarean delivery in global terms (85.6%).
Reinforcement in the epidural or intravenous was needed for group L-3.75 in 25.5% of patients, no difference whether they showed history of abdominal surgery or not. In group L-5 reinforcement was necessary only in patients with previous surgery with an incidence of 11.8%. There were found statistically significant differences between pH and type of Rea's neonate in the two groups, being related to maternal hypotension, in the group of L-3.75 overall results were better. There were no differences in other side effects analyzed: drowsiness, itching, bradycardia and trembling.
Conclusions: We didn't find any statistically significant difference in the incidence of hypotension, although the trend was favourable in the group L-3.75. The maternal hypotension was associated with fetal acidosis.
The use of combined techniques allows guaranteeing the patient’s safety through a low dose usage. The ultra-low doses could be an alternative to consider in cases of infants which mother's hemodynamic stability is one of the key components for their survival. However, we need to keep looking for multimodal therapies that will lead to achieve the desired maternal hypotension “0”.
-Teoh et al. Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75mg for caesarean delivery: a randomized controlled trial. Int J Obstet Anesthe, 2006.15(6):273-8
-Leo et al. A randomized comparasion for low doses of hyperbaric bupivacaine in combined spinal-epid