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Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial.
Int J Obstet Anesth 2006; 15(4):273-8IJ

Abstract

BACKGROUND

We wished to investigate the feasibility of an ultra low-dose combined spinal-epidural technique in providing surgical anesthesia for uncomplicated cesarean deliveries in a randomized, double-blind controlled trial.

METHOD

Forty-four normotensive, non-obese patients were randomized to receive either intrathecal hyperbaric bupivacaine 3.75 mg (low dose group, n=22) or 9 mg (conventional group, n=22), in addition to intrathecal fentanyl 25 microg, morphine 100 microg, and epidural 1.5% lidocaine 3 mL. Sensorimotor anesthesia and hemodynamic data were assessed at 2.5-min intervals for the first 15 min.

RESULTS

The maximal sensory block achieved in the low-dose group was significantly lower than that in the conventional group (median T3, [range T2-T6] vs. T2 [C2-T6], P<0.001) with a longer time taken to reach maximal sensory block. The low-dose group had less motor block, faster sensory regression to T10 dermatome and faster motor recovery to Bromage 0 (all P<0.001). The block failed to reach T6 bilaterally within 10 min in one patient in the low-dose group and two in the conventional group, with no significant difference in the need for epidural supplementation before or after delivery of the baby. The low-dose group experienced less hypotension (14% vs. 73%, P<0.001) with less ephedrine usage (0.68 vs. 17.5 mg, P<0.001). There was no difference in operating conditions and other side effects (shivering, pruritus).

CONCLUSION

We conclude that this technique results in a significantly lower incidence of maternal hypotension and has a role in high-risk parturients in whom maintenance of stable hemodynamics is imperative.

Authors+Show Affiliations

Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore. teohwendy@yahoo.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16774830

Citation

Teoh, W H L., et al. "Ultra-low Dose Combined Spinal-epidural Anesthesia With Intrathecal Bupivacaine 3.75 Mg for Cesarean Delivery: a Randomized Controlled Trial." International Journal of Obstetric Anesthesia, vol. 15, no. 4, 2006, pp. 273-8.
Teoh WH, Thomas E, Tan HM. Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial. Int J Obstet Anesth. 2006;15(4):273-8.
Teoh, W. H., Thomas, E., & Tan, H. M. (2006). Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial. International Journal of Obstetric Anesthesia, 15(4), pp. 273-8.
Teoh WH, Thomas E, Tan HM. Ultra-low Dose Combined Spinal-epidural Anesthesia With Intrathecal Bupivacaine 3.75 Mg for Cesarean Delivery: a Randomized Controlled Trial. Int J Obstet Anesth. 2006;15(4):273-8. PubMed PMID: 16774830.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial. AU - Teoh,W H L, AU - Thomas,E, AU - Tan,H M, Y1 - 2006/06/13/ PY - 2006/01/01/received PY - 2006/03/01/accepted PY - 2006/6/16/pubmed PY - 2007/1/24/medline PY - 2006/6/16/entrez SP - 273 EP - 8 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 15 IS - 4 N2 - BACKGROUND: We wished to investigate the feasibility of an ultra low-dose combined spinal-epidural technique in providing surgical anesthesia for uncomplicated cesarean deliveries in a randomized, double-blind controlled trial. METHOD: Forty-four normotensive, non-obese patients were randomized to receive either intrathecal hyperbaric bupivacaine 3.75 mg (low dose group, n=22) or 9 mg (conventional group, n=22), in addition to intrathecal fentanyl 25 microg, morphine 100 microg, and epidural 1.5% lidocaine 3 mL. Sensorimotor anesthesia and hemodynamic data were assessed at 2.5-min intervals for the first 15 min. RESULTS: The maximal sensory block achieved in the low-dose group was significantly lower than that in the conventional group (median T3, [range T2-T6] vs. T2 [C2-T6], P<0.001) with a longer time taken to reach maximal sensory block. The low-dose group had less motor block, faster sensory regression to T10 dermatome and faster motor recovery to Bromage 0 (all P<0.001). The block failed to reach T6 bilaterally within 10 min in one patient in the low-dose group and two in the conventional group, with no significant difference in the need for epidural supplementation before or after delivery of the baby. The low-dose group experienced less hypotension (14% vs. 73%, P<0.001) with less ephedrine usage (0.68 vs. 17.5 mg, P<0.001). There was no difference in operating conditions and other side effects (shivering, pruritus). CONCLUSION: We conclude that this technique results in a significantly lower incidence of maternal hypotension and has a role in high-risk parturients in whom maintenance of stable hemodynamics is imperative. SN - 0959-289X UR - https://www.unboundmedicine.com/medline/citation/16774830/Ultra_low_dose_combined_spinal_epidural_anesthesia_with_intrathecal_bupivacaine_3_75_mg_for_cesarean_delivery:_a_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(06)00046-X DB - PRIME DP - Unbound Medicine ER -