Obstetric anaesthesia is emerging as one of the most demanding subspecialities of anaesthesia. Obstetric anaesthesiologists are now an integral part of the multidisciplinary team managing the high-risk obstetrics. It has been recognised that targeted training in obstetric anaesthesia helps to recognise the mothers who need special care and formulate specific plan for delivery. Among the subspecialties of anaesthesia, obstetric anaesthesia has the potential to get established early. Obstetric anaesthesiologists have the prospect of choosing either a team or an independent practice. Group practice with a multidisciplinary team can mitigate some of the constraints and allows professional fulfilment and enough time for personal, family and societal commitments. Obstetric anaesthesia is a well-paid and sought-after speciality, and a dynamic field that demands excellent clinical and interpretative skills in a rapidly changing environment.
OBJECTIVEIs to compare the anaesthetic effects of intrathecal administration of hyperbaric Bupivacaine 10 mg with isobaric Ropivacaine 15 mg for elective caesarean delivery.
METHOD100 parturients of ASA 1 and II posted for elective caesarean delivery were randomly divided into 2 groups of 50 each: Group A received intrathecal 0.5% Hyperbaric Bupivacaine 10 mg and Group B received intrathecal 0.75% isobaric Ropivacaine 15 mg. Time of onset and regression of sensory and motor blocks, haemodynamics, time of first complaint of pain, neonatal APGAR and side-effects were evaluated.
RESULTSRopivacaine group has significantly slower onset of sensory analgesia at T6 (4.45±0.03 in Ropivacaine group as against 2.38±0.36 in Bupivacaine group, p <0.05), slower onset of Grade 3 motor block (6.46±2.48 in Ropivacaine group, 3.06±0.9 in Bupivacaine group p <0.05) and shorter duration of motor block (102.50±11.09 in Ropivacaine group as against 120.30±11.10 in Bupivacaine group p <0.05). Faster regression of the block to L1 and S2 was noticed in Ropivacaine group. (Regression to L1 122.6±20.5 in Ropivacaine and 144.10±28.19 in Bupivacaine group, p <0.05; Complete sensory regression to S1 150.0±14.8 in Ropivacaine and 169.6±20.4 in Bupivacaine group; p <0.05). Time to first complaint of pain was comparable in both the groups (168.9±26.0 in Ropivacaine and 170.2±25.5 in Bupivacaine group p >0.05). There was no difference in the haemodynamics and neonatal APGAR. Neither of the groups had any significant intraoperative or postoperative complications.
CONCLUSIONIntrathecal Isobaric Ropivacaine 15 mg provides effective spinal anaesthesia for caesarean delivery. It has slower onset, shorter motor block, early sensory regression and similar postoperative analgesia and APGAR scores as compared to 10 mg of 0.5% hyperbaric bupivacaine. The shorter duration of motor block can facilitate early ambulation and makes Ropivacaine a good alternative for elective caesarean deliveries.
KEYWORDSRopivacaine, Bupivacaine, Anaesthesia, Caesarean Deliveries.
HOW TO CITE THIS ARTICLE:Konda RRM, Anpuram LN, Chakravarthy K. A study of hyperbaric bupivacaine versus isobaric ropivacaine for elective caesarean deliveries.
EFM was introduced into widespread clinical practice in the 1970s to 1980s on the premise that it would facilitate early detection of abnormal FHR patterns thought to be associated with hypoxia thus allowing earlier intervention to prevent foetal neurological damage and/or death. There is a lack of evidence of benefit supporting the use of the admission CTG in low-risk pregnancy. In this study we the aim to evaluate the effects of Cardiotocograph Foetal Monitoring on perinatal outcome in low risk Obstetric population and determine the cost effective and reliable method of fetal monitoring that is applicable to low-risk population.
METHODOLOGYA prospective randomized study conducted on 200 low risk pregnant women in labour divided into 2 groups of 100 each. Group A includes those monitored with admission CTG and Group B includes those monitored with intermittent auscultation (IA).
OBSERVATION AND RESULTSThe demographic features, parity and gestational age in both the groups were comparable; 10 out of the 100 in CTG group had meconium stained liquor whereas 15 of them had meconium in IA group; 71% of the patients in CTG group had normal delivery, whereas it was 84% in IA group. Incidence of LSCS was 23% in CTG group as against 9% in IA group. A 'P' value of 0.02, RR of 2 5 for operative deliveries in CTG group was observed which was significant. Incidence of AVD was 6% in CTG group and 7% in IA group with a p value of <0.05, which is statistically significant. The incidence of MSL, APGAR scores at 1, 5 and 10 minutes and NICU admissions were comparable in both the groups. There was no significant difference in babies with low APGAR <7 at 5 min and NICU admissions in both the groups. In our study the sensitivity of CTG was 63.63%, specificity 80.35%, positive predictive value 33.3%, negative predictive value 94.93%. The low sensitivity and high false positives led to the intervention in delivery and increase in operative delivery with no difference in perinatal outcome.
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