Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Abstract

CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: Baricity is an important determinant of block characteristics of the spinal component of a combined spinal epidural (CSE) for labour analgesia. This study compares the analgesic efficacy and side effects of intrathecally administered plain and hyperbaric bupivacaine (both with fentanyl) during active labour.Methods: Sixty-two women in active labour (cervical dilatation ≥ 5 cm and pain score > 5) were randomized in a prospective, single-blinded fashion to receive 2.5 mg of either hyperbaric or plain bupivacaine both combined with 15 µg of fentanyl as the spinal component of a CSE. The primary outcome was failure of satisfactory analgesia within ten minutes of the intrathecal injection as defined by a verbal pain score > 3. Secondary outcomes included need for rescue analgesia, hypotension, respiratory depression, nausea and vomiting, pruritus and sustained fetal bradycardia. Results: Sixty patients were analyzed. The failure rates were 20% in the hyperbaric group vs 0% in the plain group (P = 0.024). The plain solution provided faster onset, higher sensory levels and less motor block at all times during the first 30 min. The incidence of both pruritus and sustained fetal bradycardia was 33% in the plain group and 10% in the hyperbaric group (P = 0.03). Conclusion:A plain rather than hyperbaric solution of bupivacaine 2.5 mg with fentanyl 15 µg provides a faster onset of analgesia, higher sensory levels and less motor block, while demonstrating an increased incidence of pruritus and sustained fetal bradycardia.

The role of combined spinal epidural analgesia for labour: is there still a question?

“…In this issue of the Journal, Rofaeel et al 1 report on a CSE study, examining hyperbaric bupivacaine vs isobaric bupivacaine. The study finds that when added to intrathecal (IT) sufentanil 2.5 µg, isobaric bupivacaine 2.5 mg, the standard dose which many anesthesiologists use, provides better analgesia within the first ten minutes post injection, compared to a 2.5-mg dose of hyperbaric bupivacaine.…”

“…Dans ce numéro du Journal, Rofaeel et al 1 font un compte-rendu d'une étude au sujet de la RPC qui compare la bupivacaïne hyperbare à la bupivacaïne isobare. L'étude a trouvé que, lorsqu'elle est ajoutée à du sufentanil intrathécal (IT) 2,5 µg, la bupivacaïne isobare (2,5 mg -la dose standard que de nombreux anesthésiologistes utilisent) offre une meilleure analgésie dans les dix premières minutes post-injection, qu'une dose de 2,5 mg de bupivacaïne hyperbare.…”

A comparison of the effects of hyperbaric and isobaric bupivacaine spinalanesthesia on hemodynamics and heart rate variability

“…Studies comparing hyperbaric and isobaric bupivacaine reported variable results on spinal anesthesiainduced hypotension (11)(12)(13)(14). In addition to their role in predicting hypotension due to spinal anesthesia, HRV parameters also undergo significant changes following spinal anesthesia (9,10,15,16).…”

Activity-Directed Fractionation ofPleurotus ostreatus. in the Search for Analgesics

“…Studies of plain versus hyperbaric solutions in intrathecal application of analgesics have shown a similar effect (Srivastava et al, 2004), less effect (Rofaeel et al, 2007), and less side effects (Caute et al, 1988) in the hyperbaric application. However, the effect of trehalose in oral administration of analgesics is not known.…”