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Spinal anaesthesia with low-dose bupivacaine in marginally hyperbaric solutions for caesarean section: A randomised
Wen-Xi Tang1, Jian-Jun Li, Hui-Min Bu
1From the Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Department of Anesthesia, Qilu Hospital (Qingdao), Shandong University, Qingdao (W-XT), Department of Anesthesia, Qilu Hospital, Shandong University, Jinan (J-JL), Department of Anesthesia, Dongying People's Hospital Affiliated to Binzhou Medical University, Dongying (H-MB) and Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China (Z-JF).
Background:
Conventional hyperbaric spinal anaesthesia solution (SAS) with 8% glucose and low-dose bupivacaine may reduce the incidence of hypotension in caesarean section compared to standard doses, and marginally hyperbaric SAS (≤0.8% glucose) can induce a lower block level and a lower incidence of hypotension in nonobstetric patients than conventional 8% glucose SAS.
Objective:
The objective of this study was to evaluate the clinical efficacy of marginally hyperbaric low-dose bupivacaine solutions used for spinal anaesthesia during caesarean section.
Design:
A randomised, controlled clinical trial.
Setting:
Single medical centre.
Patients:
One hundred twenty women scheduled for elective caesarean section were randomised into four groups.
Interventions:
Caesarean section after combined spinal-epidural anaesthesia using hyperbaric preparations of low-dose SAS (7.2 mg bupivacaine and 2 μg 1.6 ml sufentanil in one of the following: 8%, 0.8%, 0.5% or 0.33% glucose solution.
Main Outcome Measures:
The dermatomal sensory block and degree of motor block of the lower extremities and adverse effects of anaesthesia were recorded.
Results:
The maximum cephalad sensory block level and the incidence of hypotension decreased as the density of SAS fell (T1, T2, T4 and T6, P < 0.001; 48.3, 30, 13.3 and 10.3%, P = 0.003). The incidence of shivering reduced with decreasing density of SAS (P < 0.05). There was no significant difference in the quality of anaesthesia (efficacy of motor block and sensory block) between the groups (P > 0.05).
Conclusion:
Compared with conventional 8% glucose hyperbaric SAS, marginally hyperbaric (0.5 or 0.33% glucose) low-dose bupivacaine solutions led to a significantly lower height of cephalad spread and incidence of hypotension with no impact on the efficacy of spinal anaesthesia for caesarean section.
