Does the Baricity of Bupivacaine Influence Intrathecal Spread in the Prolonged Sitting Position Before Elective Cesarean Delivery? A Prospective Randomized Controlled Study

Loubert, Christian; Hallworth, S.; Ferando, Roshan; Columb, Malachy O.; Patel, N.; Saragn, Kavita; Sodhi, V.

doi:10.1097/sa.0b013e318254da86

Cited by 7 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, the use of hypobaric LA in obstetric practice is unpopular because of its unpredictable spread and greater inter‐patient variability as compared to hyperbaric LA . However, Loubert et al . found that hyperbaric solution had a higher rate of block failure compared to hypobaric solution when prolonging the sitting position after spinal injection.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, as compared to iso‐ or hypobaric LA, hyperbaric LA may lead to more caudal spread, resulting in insufficient block level when CSEA is induced in a sitting position, while it produces more cephalad spread in a lateral position, thus resulting in higher incidences of hypotension, nausea, and vomiting . We believe that a sitting position may favor the cephalad spread of hypobaric LA and reach an adequate sensory block for surgical incision.…”

Section: Introductionmentioning

confidence: 87%

“…Hyperbaric LA may also increase the incidence of nerve tissue damage, so our center mainly uses 0.5% hypobaric ropivacaine in CSEA. Hypobaric or plain (some are slightly hypobaric) LA are also used in spinal anesthesia for cesarean delivery in some centers . Effects of different body positions on induction of CSEA with hypobaric ropivacaine have not been reported.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Shen

Zhang

et al. 2016

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…The sitting position is frequently used for induction of spinal anesthesia. Hyperbaric solutions, under the influence of gravity, would be expected to spread caudally, whereas isobaric solutions would be expected to distribute rostrally [2,9,10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery

Helmi

Uyun

Suwondo

et al. 2014

Journal of Anesthesiology

View full text Add to dashboard Cite

Objective. The ideal local anesthetic solution for intrathecal use has rapid onset and reliable duration, with less incidence of adverse events. This study was aiming to compare the onset of anesthesia and duration of action of isobaric and hyperbaric bupivacaine for subarachnoid block (SAB).Methods. Sixty patients who underwent lower abdominal, hips, and lower extremity surgeries were randomized into two groups. Group I received 20 mg of 0.5% isobaric bupivacaine, while Group H received 20 mg of 0.5% hyperbaric bupivacaine. Injection was made intrattecally in midline position at L3-4 interspace in sitting position.Results. The onset of analgesia and motor blocks with isobaric was faster when compared to hyperbaric bupivacaine (4.8 ± 2.2 versus 7.5 ± 2.2 minutes and 4.1 ± 2.1 versus 6.4 ± 2.4 minutes, resp.,P<0.001). The duration of sensory and motor blocks was longer in isobaric when compared to hyperbaric bupivacaine (276 ± 30 versus 163 ± 22 minutes and 266 ± 32 versus 163 ± 24 minutes,P<0.001). In both groups, hemodynamic changes were not clinically relevant, and the adverse effects were comparable.Conclusion. Isobaric produced more rapid onset and longer duration when compared to hyperbaric bupivacaine.

show abstract

“…Among 14 excluded articles, two articles were excluded due to a lack of detailed information. The remaining 12 articles did not fulfil our inclusion criteria and were excluded for the following reasons: three out of the 12 excluded studies used hypobaric bupivacaine group ; one used mepivacaine ; two studies used tetracaine instead of bupivacaine ; three studies used combined spinal‐epidural technique with the addition of local anaesthetics into epidural space (although we only extracted data from the patients who had spinal anaesthesia without epidural injection); one study used differing concentration of isobaric and hyperbaric bupivacaine ; whereas two studied employed sequential administration of isobaric and hyperbaric bupivacaine . Further details are given in the full Cochrane version .…”

Section: Resultsmentioning

confidence: 99%

Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section: a Cochrane systematic review

et al. 2017

View full text Add to dashboard Cite

Both isobaric and hyperbaric bupivacaine have been used for spinal anaesthesia for elective caesarean section, but it is not clear if one is better than the other. The primary objective of this systematic review was to determine the effectiveness and safety of hyperbaric bupivacaine compared with isobaric bupivacaine administered during spinal anaesthesia for elective caesarean section. We included 10 studies with 614 subjects in the analysis. There was no evidence of differences either in the risk of conversion to general anaesthesia, with a relative risk (95%CI) of 0.33 (0.09-1.17) (very low quality of evidence), or in the need for supplemental analgesia, the relative risk (95%CI) being 0.61 (0.26-1.41) (very low quality of evidence). There was also no evidence of a difference in the use of ephedrine, the amount of ephedrine used, nausea and vomiting, or headache. Hyperbaric bupivacaine took less time to reach a sensory block height of T4, with a mean difference (95%CI) of -1.06 min (-1.80 to -0.31). Due to the rarity of some outcomes, dose variability, use of adjuvant drugs and spinal technique used, future clinical trials should look into using adequate sample size to investigate the primary outcome of the need for supplemental analgesia.

show abstract

Does the Baricity of Bupivacaine Influence Intrathecal Spread in the Prolonged Sitting Position Before Elective Cesarean Delivery? A Prospective Randomized Controlled Study

Cited by 7 publications

References 0 publications

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Combined spinal‐epidural anesthesia with hypobaric ropivacaine in sitting position significantly increases the incidence of hypotension in parturients undergoing cesarean section

Comparison of Intrathecal Use of Isobaric and Hyperbaric Bupivacaine during Lower Abdomen Surgery

Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section: a Cochrane systematic review

Contact Info

Product

Resources

About