Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine

Abstract

Background. It was suggested that labor may influence the spread of intrathecal bupivacaine using combined spinal epidural (CSE) technique. However, no previous studies investigated this proposition. We designed this study to investigate the spinal block characteristics of plain bupivacaine between nonlaboring and laboring parturients using CSE technique. Methods. Twenty-five nonlaboring (Group NL) and twenty-five laboring parturients (Group L) undergoing cesarean delivery were enrolled. Following identification of the epidural space at the L3-4 interspace, plain bupivacaine 10 mg was administered intrathecally using CSE technique. The level of sensory block, degree of motor block, and hemodynamic changes were assessed. Results. The baseline systolic blood pressure (SBP) and the maximal decrease of SBP in Group L were significantly higher than those in Group NL (P = 0.002 and P = 0.03, resp.). The median sensory level tested by cold stimulation was T6 for Group NL and T5 for Group L (P = 0.46). The median sensory level tested by pinprick was T7 for both groups (P = 0.35). The degree of motor block was comparable between the two groups (P = 0.85). Conclusion. We did not detect significant differences in the sensory block levels between laboring and nonlaboring parturients using CSE technique with intrathecal plain bupivacaine.

Assessment of block level with cold or pin-pirick stimulation during bupivacaine induced spinal anesthesia

“…Tang ve arkadaşlarıysa, soğuk uyaranıyla duyusal blok seviyesini T 6 ve pinprick uyaranıyla duyusal blok seviyesini T 7 olarak bulmuş-lardır 12 . Ousley ve arkadaşlarının yaptığı çalışmada ise…”

“…Shinichi ve arkadaşlarının yaptığı çalışmanın tersine, bizim çalışmamızda soğuk uyaranıyla pinprick uyarana göre daha düşük seviyede duyusal blok olduğu gösterilmiştir 7 .Russell diferansiyel blok seviyesinde pinprick'le ve dokunmayla, soğuk duyuları arasında ortalama iki segmentlik fark olduğunu belirlemiş, bununla beraber duyusal blok seviyesinin soğuk ve pinprick duyusunda, dokunma duyusuna göre 1-3 segment yukarıda olduğunu göstermiştir11 . Tang ve arkadaşlarıysa, soğuk uyaranıyla duyusal blok seviyesini T 6 ve pinprick uyaranıyla duyusal blok seviyesini T 7 olarak bulmuşlardır12 . Ousley ve arkadaşlarının yaptığı çalışmada ise…”