Comparison between 10 and 12 mg doses of intrathecal hyperbaric (0.5%) bupivacaine on sensory block level after first spinal failure in cesarean section: A double-blind, randomized clinical trial

Abstract

BackgroundReducing adverse effects during cesarean delivery and improving the quality of sensory blocks with appropriate doses of intrathecal hyperbaric bupivacaine can play an important role in the safe management of cesarean delivery. The aim of this study was to compare the doses of 10 and 12 mg of intrathecal hyperbaric bupivacaine 0.5% on sensory block level after first spinal failure in cesarean section (CS).MethodsIn this double-blind, randomized clinical trial, 40 candidates of CS after first spinal failure with class I-II based on American Society of Anesthesiologists (ASA) were randomly assigned into two equal groups (n = 20). Group A and B received the spinal anesthesia with 10 mg and 12 mg of hyperbaric bupivacaine (0.5%), respectively. Maximum levels of sensory block, motor block quality, and vital signs were measured in two groups by 60 min after SPA. Incidence of SPA complications during surgery were also recorded. Data were analyzed by SPSS ver.21 software using repeated measures analysis of variance at 95% confidence interval (CI) level.ResultsExcellent quality of sensory blocks and complete quality of motor blocks were achieved in all participants (100%). However, the mean time to onset of anesthesia (4.47 ± 0.69 vs. 3.38 ± 0.47, P < 0.001) and time to reach T10 level (60.73 ± 11.92 vs. 79.00 ± 19.21, P < 0.001) in the Group A, were significantly shorter than in the patients of Group B. The incidence of hypotension (P = 0.001), nausea/vomiting (P = 0.007) and bradycardia (P = 0.012) as well as administration of ephedrine and atropine were significantly higher in Group B compared to Group A.ConclusionSpinal anesthesia can be safely repeated with a 10 mg of hyperbaric bupivacaine 0.5% in a caesarean section after the initial spinal failure.Clinical trial registration[https://en.irct.ir/trial/40714], identifier [IRCT20120915010841N20].

Accessing the Efficacy and Peri-Operative Adverse Effects of Three Different Hyperbaric Bupivacaine 0.5% Dosages for Spinal Anesthesia Induction in Lower Limb Orthopedic Surgeries: A Randomized Clinical Trial

“…Although individual reactions to HB-bupivacaine are idiosyncratic, more adverse reactions co-exist with higher-dose injections(8). However an inappropriate low-dose injection of the anesthetics followed by SA failure (15). Many efforts have been made to recognize the best dosage of HB-bupivacaine for SA, but the results are controversial.…”

“…Manouchehrian et al in a double-blinded RCT compared the e cacy of two doses of HB-bupivacaine 0.5% (10 mg and 12 mg) in cesarean section (15). They claimed that a lower dose of HB-bupivacaine was safer and more hypotension and bradycardia were associated with a higher dose of HB-bupivacaine.…”

Patient‐controlled intravenous administration of dexmedetomidine with nalbuphine versus sufentanil for post cesarean delivery analgesia: A retrospective observational study

“…Respiratory monitoring was done every 4 h for 48 h. Respiratory depression was defined as a respiratory rate <10/min and treated with naloxone 22 . Cardiovascular events mainly included hypotension (BP < 90/60 mmHg, treated with 10 mg ephedrine) and bradycardia (HR < 60/min, treated with 0.5 mg atropine) 23 . Patient satisfaction was assessed using the Likert's scale from patients at 48 h post operation.…”

“…22 Cardiovascular events mainly included hypotension (BP < 90/60 mmHg, treated with 10 mg ephedrine) and bradycardia (HR < 60/min, treated with 0.5 mg atropine). 23 Patient satisfaction was assessed using the Likert's scale from patients at 48 h post operation. The scale was defined as follows 24 : 1, very dissatisfied; 2, somewhat dissatisfied; 3, neither satisfied nor dissatisfied; 4, somewhat satisfied; and 5, very satisfied.…”

Isobaric Levobupivacaine Versus Hyperbaric Bupivacaine in Pregnant Women Undergone Cesarean Sections: A Randomized Controlled Trial

“…However, hyperbaric bupivacaine can lead to profound motor block and cause maternal hypotension more frequently than desired, potentially compromising maternal and fetal wellbeing (Durodola et al, 2021). While hyperbaric bupivacaine provides reliable sensory and motor blockade, its association with hypotension can necessitate additional interventions, which may have their own risks (Manouchehrian et al, 2022). Isobaric levobupivacaine, on the other hand, is an emerging alternative to hyperbaric bupivacaine for spinal anesthesia in CS (Maheshwari et al, 2019).…”