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26337 - MINI-DOSE SPINAL BUPIVACAINE FOR CASEAREAN SECTION.

Ottawa Hospital - Civic Campus, Ottawa, ON, Canada

Introduction

Maternal hypotension complicates 60–94% of Caesarean deliveries when 10–15 mg of bupivacaine is used1. These does of bupivacaine are associated with extensive motor blockade and unpleasant intraoperative claustrophobia2. Reducing the dose of bupivacaine to 5 mg decreases the incidence of hypotension, nausea, and the quantity of vasopressor used3. The primary objective of this study was to evaluate the effect of mini dose bupivacaine spinal anesthesia on maternal hemodynamics. The secondary objective was to determine if anticipated reductions in hypotension, nausea, and motor blockade are reflected in increased patient satisfaction.

Methods

Following Research Ethics Board approval and written informed consent 52 healthy term parturients undergoing elective Caesarean delivery were randomly assigned to mini (4.5 mg) and conventional (12 mg) dose bupivacaine spinal anesthesia. All patients received similar intrathecal doses of fentanyl (50 mcg) and morphine (200 mcg). Group allocation was concealed from the patient, surgeon, anesthesiologist, and study personnel. Maternal hemodynamics, and sensorimotor levels were recorded at regular intervals. Intravenous fluid administration and vasopressor use was standardized. Side effects were documented. Quality of Recovery4 was assessed on postoperative days 1, 2, and 3.

Results

A total of 55 women were recruited. Two women were withdrawn after randomization when their surgery was postponed and a third was excluded for pre-operative hypertension. The remaining 52 women completed the study protocol. Demographic characteristics of subjects in both groups were similar. Block characteristics and side effects are summarized in Table 1. Use of supplemental analgesia in both groups was statistically similar (5 of 27 mini-dose vs 1 of 25 conventional dose, p = 0.190). Hemodynamic measurements and use of ephedrine were similar in both mini and conventional dose groups.

Minidose intrathecal bupivacaine provided anesthesia comparable in most regards to conventional doses. Patients receiving minidose bupivacaine did, however, experience significantly less motor blockade of shorter duration. Nausea and pruritus were common in both groups and likely result from the relatively large doses of fentanyl used in this protocol.

References

1 Can J Anesth 2002;49(6):588–99.[Abstract/Free Full Text]

2 Can J Anesth 1993;40:346–56.[Abstract/Free Full Text]

3 Reg Anesth Pain Med 2000;25(3):235–9.[Medline]

4 Anesth Analg 1999;88:83–90.[Abstract/Free Full Text]

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