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Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery

[Une faible dose de bupivacaïne intrathécale lors de l’accouchement par césarienne ne réduit pas l’hypotension, mais accélère la récupération motrice]

Gregory L. Bryson, MD FRCPC MSc^*, Robert MacNeil, MD FRCPC^*, Leo M. Jeyaraj, MBBS FRCA and Ola P. Rosaeg, MB BCh FRCPC

^* From the Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario, Canada; the
Department of Anaesthesia, James Cook University Hospital, Middlesbrough, United Kingdom; and the
Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland.

Address correspondence to: Dr. Gregory L. Bryson, Department of Anesthesiology, Box 249C, The Ottawa Hospital – Civic Campus, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. E-mail: glbryson{at}ohri.ca

Background: Maternal hypotension occurs in 60–94% of Cesarean deliveries with 10–15 mg spinal bupivacaine. Reduced doses of bupivacaine may decrease the incidence of hypotension, nausea, and vasopressor use. The primary objective of this study was to compare 4.5 mg and 12 mg doses of intrathecal bupivacaine on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in side effects were reflected in increased patient satisfaction.

Methods: Following Research Ethics Board approval and informed consent 52 term parturients undergoing elective Cesarean delivery were randomly assigned to isobaric bupivacaine 4.5 mg or hyperbaric bupivacaine 12 mg for spinal anesthesia. All patients received fentanyl 50 µg and morphine 200 µg intrathecally. Intravenous fluid and vasopressor administration were standardized. Maternal hemodynamics, and sensorimotor levels were recorded at regular intervals. Side effects and patient satisfaction were documented.

Results: Median cepahalad sensory block was C8 in both groups (NS) but the intensity of motor block was significantly less (P < 0.001) and of shorter duration (P < 0.001) with bupivacaine 4.5 mg. The proportion of patients requiring ephedrine (> 70%) and the quantities of ephedrine used were similar in both groups (NS). Use of supplemental analgesia, side effects, and measures of patient satisfaction were comparable in both groups.

Discussion: Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.

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