Bupivacaine in Paracervical Block—plasma Levels and Changes in Maternal and Foetal Acid-Base Balance

Hollmén, A; Korhonen, Mikko; Ojala, A

doi:10.1093/bja/41.7.603

Cited by 20 publications

(6 citation statements)

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“…The fetomaternal drug ratio was low in this investigation. This is in agreement with studies of Hollmen et al (20), Reynolds and Taylor (44), Hyman et al (22) and Belfrage el al. (1,2), if small doses of bupivacaine were used.…”

Section: Discussionsupporting

confidence: 93%

Continuous Mini‐infusion of Bupivacaine Into the Epidural Space During Labor

Matouskova

Hanson

1979

Acta Obstet Gynecol Scand

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Mini-infusion of 0.25 per cent bupivacaine plain into the epidural space was used in 16 healthy women for pain relief during labor. After a loading dose, continuous administration was ensured by using an automatic pump at an infusion rate of 5 or 8 ml per hour.Maternal venous blood concentrations of bupivacaine were determined 20, 40, and 60 minutes after the loading dose. Further samples were taken hourly until delivery. Fetal blood concentrations were determined from fetal scalp blood during mini-infusion, and from umbilical venous blood at delivery. Maternal blood levels averaged 206 ng/ml. The maximum concentration (604 ng/ml) did not exceed 30 per cent of the toxic level. The blood concentration of bupivacaine did not tend to increase during the course of continuous infusion. Tachyphylaxis could not be detected statistically. The fetal blood concentration during blockade averaged 58 ng/ml, giving a feto-maternal ratio of 0.28. The neonatal-maternal ratio, calculated from the umbilical venous blood, was 0.32. With a shift of the acid-base status towards acidosis in the neonate, the ratio of bupivacaine slightly increased. Absence of maternal hypotension as well as absence of fetal heart irregularities during infusion may be attributed to the low and stable blood concentration of bupivacaine. The mean Apgar score was 9.5 at one minute and 9.9 at five minutes. The maternal arterial acid-base balance at delivery was normal. The fetal acid-base status at delivery showed wide variation, without any relation to the Apgar score or the total dose of bupivacaine. It is concluded that continuous mini-infusion of bupivacaine by means of an automatic pump has advantages over intermittent administration.

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Section: Discussionsupporting

confidence: 93%

Continuous Mini‐infusion of Bupivacaine Into the Epidural Space During Labor

Matouskova

Hanson

1979

Acta Obstet Gynecol Scand

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“…The bupivacaine concentrations in both mother and baby at delivery were well within the safety range of 1.5-2.3 \ig ml"' (Widman, 1966;Jorfeldt, et al, 1968;Hollmen, Kerhonen and Ojala, 1969;Reynolds and Taylor, 1971). The higher maternal bupivacaine concentraton in the groups receiving an infusion probably related to the higher total dose used in these mothers.…”

Section: Discussionmentioning

confidence: 81%

Continuous Extradural Infusion of 0.0625% or 0.125% Bupivacaine for Pain Relief in Primigravid Labour

Rees

Rosen

1985

British Journal of Anaesthesia

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The efficacy of an extradural infusion of 0.0625% or 0.125% bupivacaine was studied in 98 primigravid mothers in active labour. No special measures were taken to posture the mother (except to avoid aorto-caval compression). The study regimen included a control group (no infusion) receiving intermittent top-ups (0.25%. bupivacaine 8-10 ml), two groups receiving bupivacaine 6.25 mg h-1 infusion in different concentrations (0.0625% and 0.125%), a fourth group receiving 0.125% bupivacaine 12.5 mg h-1 infusion, and a fifth group receiving 0.125% bupivacaine 18.75 mg h-1 infusion. The optimum infusion rate was 0.125% bupivacaine 10 ml h-1, at which 69% of primigravid mothers required none or only one "top-up" of 0.25% bupivacaine 8-10 ml during a mean duration of 7.1 h labour. In the group who had no extradural infusion, only 32% of mothers managed with one or no top-up. The median interval between top-ups was increased from 145 min in the no infusion group to 245 min in those mothers receiving 0.125% bupivacaine 10 ml h-1 by infusion. Increasing the rate of infusion to 15 ml h-1 did not improve the results. Spread of local anaesthetic to higher levels was limited (less than T5) so that testing sensory loss at the T5-6 level at 2-hourly intervals should detect accidental spinal blockade resulting from inadvertent intrathecal infusion.

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“…Bradycardia lasting on average for 8 minutes and starting 2-4 minutes after PCB was observed at a 12% rate. TERAMO [16], by using 100mg or 50 mg of bupivacaine, found a 21 % frequency of bradycardia, HOLLMEN [6] a rate of 30%, JÄGERHORN [10] a 10% rate but MEIS [12] and REID [14] almost none. Comparison of FHR patterns after PCB are difficult because most earlier studies have not been done with direct FHR recording and also the criteria of pathological and non-pathological FHR patterns, e.g.…”

Section: Discussionmentioning

confidence: 99%