Low-dose bupivacaine-fentanyl spinal anesthesia for cesarean delivery

Area of Science:

• Anesthesiology
• Obstetric Anesthesia
• Regional Anesthesia

Background:

• Hypotension is a common complication of spinal anesthesia during cesarean delivery.
• Intrathecal opioids enhance local anesthetic effects, potentially reducing hypotension.
• Optimizing spinal anesthesia for cesarean delivery is crucial for maternal safety.

Purpose of the Study:

• To evaluate the efficacy of a minidose bupivacaine-fentanyl spinal combination for cesarean delivery.
• To compare the incidence of hypotension and associated vasopressor requirements with standard bupivacaine spinal anesthesia.
• To assess patient-reported outcomes such as nausea.

Main Methods:

• A randomized study involving 32 women undergoing cesarean delivery.
• Two groups received spinal anesthesia: 10 mg plain bupivacaine or 5 mg bupivacaine with 25 mcg fentanyl.
• Hypotension defined as systolic blood pressure <95 mm Hg or >25% decrease from baseline, treated with ephedrine.

Main Results:

• The minidose bupivacaine-fentanyl group experienced significantly less hypotension (31% vs. 94%) and required less ephedrine (2.8 mg vs. 23.8 mg).
• Higher sensory block levels and more intense motor block were observed in the plain bupivacaine group.
• Nausea was reported less frequently in the minidose bupivacaine-fentanyl group (31% vs. 69%).

Conclusions:

• A spinal regimen of 5 mg bupivacaine plus 25 mcg fentanyl provides effective anesthesia for cesarean delivery.
• This combination results in reduced hypotension, vasopressor use, and nausea compared to 10 mg plain bupivacaine.
• Minidose bupivacaine with fentanyl is a favorable alternative for spinal anesthesia in cesarean delivery.