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Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section.
Int J Obstet Anesth. 2008 Jul; 17(3):217-22.IJ

Abstract

BACKGROUND

Hypotension during spinal anesthesia is one of the major concerns in cesarean section. To achieve adequate spinal anesthesia with less hypotension, we evaluated the viability of sequential subarachnoid injection of two different baricities of bupivacaine. We used plain bupivacaine 5mg to obtain dense anesthesia of the surgical site, followed by hyperbaric bupivacaine 5mg to achieve spread to T5 anesthesia to address visceral pain.

METHODS

In this double-blind prospective study, 72 parturients undergoing cesarean section were randomized to receive either hyperbaric bupivacaine 10mg or 5mg each of plain and hyperbaric bupivacaine sequentially for spinal anesthesia. Loss of pinprick sensation to T6 was regarded as sufficient for cesarean section to proceed. Characteristics of anesthesia, episodes of hypotension, bradycardia and ephedrine use were assessed by blinded observers.

RESULTS

Demographic data, characteristics of anesthesia, quality of intraoperative anesthesia and Apgar scores were similar in the two groups. Compared to hyperbaric bupivacaine, the combination of plain and hyperbaric bupivacaine provided a marked decrease in the incidence of hypotension (13.9% vs. 66.7%, P<0.001) and side effects related hypotension such as nausea and vomiting (13.9% vs.52.8%, P<0.001). The amount of ephedrine administered was significantly lower in the plain and hyperbaric bupivacaine group (2.2+/-1.0mg vs. 20.5+/-8.7 mg (P<0.001).

CONCLUSIONS

Sequential subarachnoid injection of plain and hyperbaric bupivacaine for cesarean section can provide reliable spinal anesthesia with a lower incidence of hypotension and vomiting.

Authors+Show Affiliations

Atatürk University, Medical Faculty, Department of Anesthesiology and Reanimation and Department of Obstetrics and Gynecology, Erzurum, Turkey. mcesur@atauni.edu.trNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18499435

Citation

Cesur, M, et al. "Spinal Anesthesia With Sequential Administration of Plain and Hyperbaric Bupivacaine Provides Satisfactory Analgesia With Hemodynamic Stability in Cesarean Section." International Journal of Obstetric Anesthesia, vol. 17, no. 3, 2008, pp. 217-22.
Cesur M, Alici HA, Erdem AF, et al. Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section. Int J Obstet Anesth. 2008;17(3):217-22.
Cesur, M., Alici, H. A., Erdem, A. F., Borekci, B., & Silbir, F. (2008). Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section. International Journal of Obstetric Anesthesia, 17(3), 217-22. https://doi.org/10.1016/j.ijoa.2007.11.007
Cesur M, et al. Spinal Anesthesia With Sequential Administration of Plain and Hyperbaric Bupivacaine Provides Satisfactory Analgesia With Hemodynamic Stability in Cesarean Section. Int J Obstet Anesth. 2008;17(3):217-22. PubMed PMID: 18499435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section. AU - Cesur,M, AU - Alici,H A, AU - Erdem,A F, AU - Borekci,B, AU - Silbir,F, Y1 - 2008/05/21/ PY - 2007/05/01/received PY - 2007/06/01/revised PY - 2007/11/01/accepted PY - 2008/5/24/pubmed PY - 2008/8/13/medline PY - 2008/5/24/entrez SP - 217 EP - 22 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 17 IS - 3 N2 - BACKGROUND: Hypotension during spinal anesthesia is one of the major concerns in cesarean section. To achieve adequate spinal anesthesia with less hypotension, we evaluated the viability of sequential subarachnoid injection of two different baricities of bupivacaine. We used plain bupivacaine 5mg to obtain dense anesthesia of the surgical site, followed by hyperbaric bupivacaine 5mg to achieve spread to T5 anesthesia to address visceral pain. METHODS: In this double-blind prospective study, 72 parturients undergoing cesarean section were randomized to receive either hyperbaric bupivacaine 10mg or 5mg each of plain and hyperbaric bupivacaine sequentially for spinal anesthesia. Loss of pinprick sensation to T6 was regarded as sufficient for cesarean section to proceed. Characteristics of anesthesia, episodes of hypotension, bradycardia and ephedrine use were assessed by blinded observers. RESULTS: Demographic data, characteristics of anesthesia, quality of intraoperative anesthesia and Apgar scores were similar in the two groups. Compared to hyperbaric bupivacaine, the combination of plain and hyperbaric bupivacaine provided a marked decrease in the incidence of hypotension (13.9% vs. 66.7%, P<0.001) and side effects related hypotension such as nausea and vomiting (13.9% vs.52.8%, P<0.001). The amount of ephedrine administered was significantly lower in the plain and hyperbaric bupivacaine group (2.2+/-1.0mg vs. 20.5+/-8.7 mg (P<0.001). CONCLUSIONS: Sequential subarachnoid injection of plain and hyperbaric bupivacaine for cesarean section can provide reliable spinal anesthesia with a lower incidence of hypotension and vomiting. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/18499435/Spinal_anesthesia_with_sequential_administration_of_plain_and_hyperbaric_bupivacaine_provides_satisfactory_analgesia_with_hemodynamic_stability_in_cesarean_section_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(07)00187-2 DB - PRIME DP - Unbound Medicine ER -