Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery

  • Gregory L. Bryson
  • Robert MacNeil
  • Leo M. Jeyaraj
  • Ola P. Rosaeg
Reports of original investigations

Abstract

Background

Maternal hypotension occurs in 60–94% of Cesarean deliveries with 10–15 mg spinal bupivacaine. Reduced doses of bupivacaine may decrease the incidence of hypotension, nausea, and vasopressor use. The primary objective of this study was to compare 4.5 mg and 12 mg doses of intrathecal bupivacaine on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in side effects were reflected in increased patient satisfaction.

Methods

Following Research Ethics Board approval and informed consent 52 term parturients undergoing elective Cesarean delivery were randomly assigned to isobaric bupivacaine 4.5 mg or hyperbaric bupivacaine 12 mg for spinal anesthesia. All patients received fentanyl 50 μg and morphine 200 μg intrathecally. Intravenous fluid and vasopressor administration were standardized. Maternal hemodynamics, and sensorimotor levels were recorded at regular intervals. Side effects and patient satisfaction were documented.

Results

Median cepahalad sensory block was C8 in both groups (NS) but the intensity of motor block was significantly less (P < 0.001) and of shorter duration (P < 0.001) with bupivacaine 4.5 mg. The proportion of patients requiring ephedrine (> 70%) and the quantities of ephedrine used were similar in both groups (NS). Use of supplemental analgesia, side effects, and measures of patient satisfaction were comparable in both groups.

Discussion

Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.

Contexte

L’hypotension maternelle se rencontre dans 60’94 % des accouchements par césarienne avec 10’15 mg de bupivacaïne intrathécale. Des doses réduites de bupivacaïne pourraient réduire l’incidence d’hypotension et de nausées, ainsi que l’utilisation de vasopresseurs. L’objectif premier de cette étude était de comparer l’effet de doses intrathécales de bupivacaïne de 4,5 mg et 12 mg respectivement sur l’hémodynamie maternelle. Le deuxième objectif était de déterminer si les réductions anticipées d’effets secondaires se reflétaient par une satisfaction accrue des patientes.

Méthode

Le Comité d’éthique de la recherche ayant donné son accord, cinquante-deux parturientes à terme devant subir un accouchement non urgent par césarienne ont été randomisées en deux groupes pour la rachianesthésie: bupivacaïne isobare 4,5 mg ou bupivacaïne hyperbare 12 mg. Toutes les patientes ont reçu du fentanyl 50 μg et de la morphine 200 μg en intrathécal. L’administration de liquide intraveineux et de vasopresseurs a été standardisée. L’hémodynamie maternelle ainsi que les niveaux sensori-moteurs ont été enregistrés à intervalles réguliers. Les effets secondaires et la satisfaction des patientes ont été documentés.

Résultats

Le bloc sensitif moyen en direction de la tête était situé à C8 dans les deux groupes (NS), mais l’intensité du bloc moteur était significativement plus faible (P < 0,001) et d’une durée moindre (P < 0,001) avec la bupivacaïne 4,5 mg. La proportion de patientes nécessitant de l’éphédrine (> 70 %) et les quantités d’éphédrine administrées étaient similaires dans les deux groupes (NS). L’utilisation d’analgésie supplémentaire, les effets secondaires et la satisfaction des patientes étaient comparables dans les deux groupes.

Discussion

Dans le cas d’accouchements par césarienne, les doses de 4,5 mget 12 mg de bupivacaïne intrathécale produisent un bloc sensitif et des effets secondaires similaires. Toutefois, les patientes ayant reçu 4,5 mg ont ressenti un bloc moteur plus faible et plus court, et cette différence était significative.

[Une faible dose de bupivacaïne intrathécale lors de l’accouchement par césarienne ne réduit pas l’hypotension, mais accélère la récupération motrice]

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Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  • Gregory L. Bryson
    • 1
  • Robert MacNeil
    • 1
  • Leo M. Jeyaraj
    • 2
  • Ola P. Rosaeg
    • 3
  1. 1.Department of AnesthesiologyThe Ottawa Hospital - Civic CampusOttawaCanada
  2. 2.Department of AnaesthesiaJames Cook University HospitalMiddlesbroughUK
  3. 3.Department of AnaestheticsNational Maternity HospitalDublin

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