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Bupivicaine dosing in parturients of short stature a case control study
Abstract Number: S4B-4
Abstract Type: Original Research
Introduction: The ED50 and ED95 of spinal bupivacaine for cesarean delivery has been well described in the literature, however these studies did not include parturients with extremes of stature. There are some data that suggest height can be correlated with onset time central neural blockade, maximal sensory level and duration of blockade. Parturients of short stature are defined as a height of ≤ 148cm and pose a challenge for dosing of neuraxial anesthesia as too high a dose can lead to high sensory levels and maternal hypotesion, while decreased doses may result in maternal discomfort or a failed spinal. We conducted a retrospective cohort study to evaluate neuraxial anesthetic dosing in parturients of short stature compared to patients of normal stature.
Methods: All parturients who delivered via cesarean delivery from between May 1, 2003 and May 1, 2013 and were a parturient of short stature without a diagnosis of dwarfism were identified through a query of billing data. Non-short stature controls who underwent cesarean delivery the same week with similar BMI were matched 2-to-1. All patients were matched on anesthetic type, for those patients who underwent combined spinal anesthesia and could not be matched on CSE were matched with spinal anesthetics. Data extracted included: patient demographics, obstetric and anesthetic information including local anesthetic dosage and adequacy of surgical blockade. Categorical data were compared using a chi-squared test, and continuous data were compared using a t-test or Mann-Whitney U test.
Results: The mean dose of bupivacaine used for spinal anesthesia in parturients of short stature was 9.8 ±1.0mg compared to 11.2 ±0.9mg in non-short stature women (P<0.0001). The mean intrathecal bupivacaine dose used in CSE anesthesia was 10.5 mg (IQR: 9-10.9) in parturients of short stature versus 11.2mg (IQR: 11.2-11.2) in the non-short stature controls (P=0.002). All but one patient achieved an adequate surgical level. There was no statistical difference between the use of adjuvant narcotics in either the spinal or the CSE cohorts between study and control patients.
Conclusions: Adequate surgical anesthesia was achieved with significantly reduced dosing of spinal bupivacaine in parturients of short stature in both the spinal and and CSE groups suggesting decreased dosing in parturients of short stature. Consideration should be given to using a lower dose of bupivacaine in these women.