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Comparing Low-Dose bupivacaine with Epidural Volume Extension to Standard Bupivacaine Dosing for Short Obstetric Procedures: A Prospective, Randomized Study
Abstract Number: T-09
Abstract Type: Original Research
Introduction: Neuraxial anesthesia is standard of care for parturients undergoing short obstetric procedures such as postpartum tubal ligation (PPTL), cerclage, and dilation & curettage. Bupivacaine is routinely used due to concerns for transient neurologic symptoms with lidocaine; however, the duration of bupivacaine greatly outlasts the procedure, and patients often spend prolonged periods of time in the post-anesthesia care unit (PACU). This prolonged PACU stay can increase healthcare costs and lead to maternal dissatisfaction. The aim of this study was to take a well-known technique – low dose intrathecal (IT) bupivacaine combined with a saline epidural volume extension (EVE) – and see if we could reduce the recovery time. A secondary aim was to determine the effectiveness of the block as low-dose bupivacaine without EVE has been shown to provide inadequate coverage for PPTL. We hypothesize that the low dose bupivacaine with EVE would provide adequate analgesia and decrease time to recovery.
Methods: 32 patients were randomized into two groups. Each group received IT bupivacaine via combined spinal-epidural. The control group (C) received our standard dose of 10 mg 0.5% isobaric bupivacaine with 12.5 mcg of fentanyl. The volume extension group (EVE) received 5 mg 0.5% isobaric bupivacaine with 12.5 mcg of fentanyl followed by 10 cc of sterile saline through the Tuohy needle. The epidural catheter was threaded in both groups. Measurements recorded included basic patient demographics, time from spinal to PACU discharge, PACU time, and spinal failure. We compared the groups using a paired t-test assuming unequal variances.
Results: The two groups did not differ with respect to BMI and age (p > 0.05). There was no difference in surgery time (C 18.9 ±5.8 min, EVE 21.3±4.4, p=0.203) but both the time from spinal anesthesia injection to discharge (C 183.9 ±59.9 min, EVE 97.3±15.9, p<0.001) and PACU time (C 138.8 ±59.2 min, EVE 52.0±12.2, p<0.001) differed significantly. There was no anesthetic failure in either group.
Conclusion: We demonstrated a significant decrease in recovery time in the EVE group. We also showed that the low dose IT bupivacaine provided adequate anesthetic coverage when combined with an EVE. Given both the significant decrease in recovery time and adequate coverage, we recommend this technique for short obstetric procedures.