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Optimal bupivacaine spinal for cervical cerclage: Effect on ambulation, urination, PACU time and pain control
Abstract Number: T 29
Abstract Type: Original Research
Cervical incompetence is thought to cause as many as 20-25% of miscarriages in the second trimester. Cervical cerclages are performed in about 4.4 per 1000 live births. Historically, many practitioners administered subarachnoid lidocaine for cerclages. Because of the increased risk of transient neurologic symptoms (TNS) other local anesthetics have been studied. Previous studies  show that bupivacaine is a suitable alternative to lidocaine for cervical cerclage. There is little data comparing the effectiveness and side effects of differing doses of spinal bupivacaine in women undergoing cervical cerclage. Our study evaluated low vs. high dose bupivacaine spinals and their side-effects.
This was a retrospective chart review. Cerclage cases were identified using our computerized anesthesia system. We reviewed all patient charts from our institution for women who underwent cervical cerclage between February 2011 to November 2012 (n=119). Patient groups were divided by dosing of intrathecal bupivacaine. We compared low dose (≤10mg) to high dose (>10mg) bupivacaine, looking at differences in time to ambulation, urination and recovery in the PACU. We also compared first time to request pain medication and maximum visual acuity score (VAS) in the PACU. Statistical analysis included chi square, Fisher’s exact test and Student’s t-test, as indicated. P< 0.05 was significant.
To date we have identified 61 patient who received spinal bupivacaine for cerclage. Forty-one patients received low dose (5.25-10mg) and 20 patients received high dose (11.25-15mg). There was a significant difference in time to ambulation (3.08 ± 0.82 hrs. vs 4.26 ± 1.04 hrs. p=0.0002), time to void (3.52 ± 0.87 hrs. vs. 4.69 ± 1.4 hrs. p=0.0097) and PACU time (3.71 ± 1.46 hrs. vs. 4.9 ± 1.36 hrs. p=0.0032) with longer times being associated with the high dose bupivacaine group. There was no significant difference in first time to request pain medication or max VAS in the PACU between the groups.
While intrathecal bupivacaine is a useful alternative to lidocaine as an anesthetic for cervical cerclage, differing doses of bupivacaine have not been compared in this patient population. Our data demonstrate that low dose bupivacaine spinals are superior to high dose with the advantage of earlier ambulation and urination and shorter PACU time, while providing equal pain control.
1. Anesth Analg 2005;100:1811-6
2. Anesth Analg 2003;97:56-61