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Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for caesarean section.
Br J Anaesth. 2009 Jun; 102(6):806-11.BJ

Abstract

BACKGROUND

Prophylactic infusion of phenylephrine to prevent hypotension at Caesarean section has been shown to decrease the rostral spread of intrathecal plain levobupivacaine and intrathecal hyperbaric bupivacaine by a median of two dermatomes compared with ephedrine. The aim of this study was to determine the median effective dose (ED50) of intrathecal bupivacaine required to achieve a block to touch at the xiphisternum in patients undergoing Caesarean section when phenylephrine or ephedrine are used to prevent hypotension.

METHODS

Seventy women were randomized in two groups to receive either phenylephrine at a rate of 16.6 microg min(-1) (concentration 1microg ml(-1)) or ephedrine at a rate of 1.5 mg min(-1) (concentration 90 microg ml(-1)). Patients received varying doses of hyperbaric bupivacaine with fentanyl 25 microg using a double-blinded, up-down sequential allocation design. Effective doses were defined as anaesthesia to touch with ethyl chloride spray to the xiphisternum within 20 min.

RESULTS

The ED50 estimates of bupivacaine were similar in the two groups: 7.8 mg [95% confidence interval (CI) 6.7-8.9] with phenylephrine and 7.6 mg (95% CI 6.8-8.4) with ephedrine. Systolic blood pressure control was similar (P=0.18) with vasopressors but heart rate was higher with ephedrine (P=0.0014).

CONCLUSIONS

Under the conditions of this study, we have shown that when phenylephrine or ephedrine were used to prevent post-spinal hypotension, the dosing requirement of hyperbaric bupivacaine was similar for intrathecal anaesthesia.

Authors+Show Affiliations

Department of Anaesthesia, Queen Charlotte's and Chelsea Hospital, Du Cane Road, London W12 0HS, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19411667

Citation

Hennebry, M C., et al. "Effect of I.v. Phenylephrine or Ephedrine On the ED50 of Intrathecal Bupivacaine With Fentanyl for Caesarean Section." British Journal of Anaesthesia, vol. 102, no. 6, 2009, pp. 806-11.
Hennebry MC, Stocks GM, Belavadi P, et al. Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for caesarean section. Br J Anaesth. 2009;102(6):806-11.
Hennebry, M. C., Stocks, G. M., Belavadi, P., Barnes, J., Wray, S., Columb, M. O., & Lyons, G. (2009). Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for caesarean section. British Journal of Anaesthesia, 102(6), 806-11. https://doi.org/10.1093/bja/aep095
Hennebry MC, et al. Effect of I.v. Phenylephrine or Ephedrine On the ED50 of Intrathecal Bupivacaine With Fentanyl for Caesarean Section. Br J Anaesth. 2009;102(6):806-11. PubMed PMID: 19411667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of i.v. phenylephrine or ephedrine on the ED50 of intrathecal bupivacaine with fentanyl for caesarean section. AU - Hennebry,M C, AU - Stocks,G M, AU - Belavadi,P, AU - Barnes,J, AU - Wray,S, AU - Columb,M O, AU - Lyons,G, Y1 - 2009/05/02/ PY - 2009/5/5/entrez PY - 2009/5/5/pubmed PY - 2009/6/19/medline SP - 806 EP - 11 JF - British journal of anaesthesia JO - Br J Anaesth VL - 102 IS - 6 N2 - BACKGROUND: Prophylactic infusion of phenylephrine to prevent hypotension at Caesarean section has been shown to decrease the rostral spread of intrathecal plain levobupivacaine and intrathecal hyperbaric bupivacaine by a median of two dermatomes compared with ephedrine. The aim of this study was to determine the median effective dose (ED50) of intrathecal bupivacaine required to achieve a block to touch at the xiphisternum in patients undergoing Caesarean section when phenylephrine or ephedrine are used to prevent hypotension. METHODS: Seventy women were randomized in two groups to receive either phenylephrine at a rate of 16.6 microg min(-1) (concentration 1microg ml(-1)) or ephedrine at a rate of 1.5 mg min(-1) (concentration 90 microg ml(-1)). Patients received varying doses of hyperbaric bupivacaine with fentanyl 25 microg using a double-blinded, up-down sequential allocation design. Effective doses were defined as anaesthesia to touch with ethyl chloride spray to the xiphisternum within 20 min. RESULTS: The ED50 estimates of bupivacaine were similar in the two groups: 7.8 mg [95% confidence interval (CI) 6.7-8.9] with phenylephrine and 7.6 mg (95% CI 6.8-8.4) with ephedrine. Systolic blood pressure control was similar (P=0.18) with vasopressors but heart rate was higher with ephedrine (P=0.0014). CONCLUSIONS: Under the conditions of this study, we have shown that when phenylephrine or ephedrine were used to prevent post-spinal hypotension, the dosing requirement of hyperbaric bupivacaine was similar for intrathecal anaesthesia. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/19411667/Effect_of_i_v__phenylephrine_or_ephedrine_on_the_ED50_of_intrathecal_bupivacaine_with_fentanyl_for_caesarean_section_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)34406-9 DB - PRIME DP - Unbound Medicine ER -