Hemodynamic effects of low-dose bupivacaine spinal anesthesia for cesarean section: A randomized controlled trial

Abstract

Background: Spinal anesthesia is the most common technique for cesarean section. The conventional local anesthetic dose has been decreasing over time to 8–12.5 mg of bupivacaine. Lower doses of bupivacaine may be associated with reduced incidence of hypotension and other complications. This low dose also may be associated with improved maternal cardiac index (CI). We hypothesized that low dose spinal anesthesia using 4.5 mg bupivacaine would result in improved maternal CI when compared with conventional dose (9 mg) intrathecal bupivacaine. Methods: This randomized controlled trial included all healthy parturients presenting for elective cesarean section. In addition to standard monitors, an arterial line was placed for pulse contour cardiac output measurement. Due to limited data on maternal cardiac output during cesarean section, we had to power our study on recovery room length of stay. Secondary outcomes included the change in maternal CI, fluid administration, vasopressor usage, maternal satisfaction, and adequacy of surgical blockade and recovery time from motor and sensory blockade. Results: The low dose group had significantly faster motor recovery times (132 [122–144] versus. 54 [48–66] min conventional versus. low-dose, respectively, P < 0.01), and a shorter recovery room stay (92 ± 21 vs 70 ± 11 min, conventional vs. low-dose, respectively, P < 0.01, 95% CI -35 to -10 min). There was no difference in CI between the conventional dose and low dose spinal groups. Both groups had a drop in CI with spinal anesthesia. The low-dose group demonstrated equivalent surgical anesthesia and block onset times compared to the conventional group. Conclusions: Low-dose spinal anesthesia provides adequate surgical anesthesia, improved recovery time, but no difference in maternal cardiac index when compared to conventional dose spinal anesthesia. NCT02046697

Effect of height-based spinal anesthetic dose versus conventional dose on hemodynamics in lower limb surgeries in geriatric patients: a randomized controlled trial

“…The total amounts of ephedrine and noradrenaline were comparable in both groups of our study, as reported by some earlier studies. 31,32 Ben-David et al, however, found a significant decline of the total amount of the vasopressor ephedrine in geriatric patients who received 4 mg bupivacaine added to fentanyl compared to 10 mg bupivacaine only in hip operations. 33 The incompatible findings might be due to the great difference between the two used doses of bupivacaine (10 vs. 4 mg) by them, while we used 12.5 vs. 9.79 mg of bupivacaine.…”

Low Dose Combined Spinal-Epidural (CSE) Anaesthesia with Blocks for Management of A High-Risk Geriatric Patient with Dilated Cardiomyopathy Posted for TURBT

“…Patients with ischemic heart disease and cardiomyopathy have increased sympathetic activity to maintain the cardiac output, and so are at increased risk of decrease in SVR with high dose spinal anaesthesia [8]. Cenkowski JM 2019 et al showed that low-dose bupivicaine group gain faster recovery of the sensory and motor blockade, early discharge, and better patient satisfaction compared to high dose bupivacaine [9]. Alsaeid et al also found that a small dose of heavy bupivacaine 0.5% (5 mg) provided better hemodynamic stability with minimal side effects in elderly patients [10].…”

Perbandingan Anestesi Spinal Bupivakain Low Dose dan Conventional Dose dalam Mencapai Adekuasi Blok Sensorik untuk Prosedur Seksio Sesarea: Penelitian Noninferioritas Acak Tersamar Tunggal

“…Pada penelitian ini didapatkan rata-rata durasi prosedur pembedahan 1: 12 Hasil ini berbeda dengan penelitian pada populasi Indonesia yang membandingkan anestesi spinal low dose pada seksio sesarea menggunakan bupivakain hiperbarik 0,5% 7,5 mg dengan 5 mg dengan 56 subjek pada masing-masing kelompok. Penelitian ini menggunakan adjuvan tunggal (fentanil 25mcg) pada kedua kelompok.…”

“…16 Selain itu posisi pasien saat obat lokal anestesi diinjeksi juga memengaruhi anestesi spinal, pada suatu penelitian membandingkan kelompok low dose dan conventional dose dengan kedua kelompok dalam posisi duduk, 7 sementara pada penelitian lain posisi duduk pada kelompok conventional dose sedangkan kelompok low dose dengan posisi miring ke kanan dan Trendelenberg 10 o . 12 Dari suatu meta-analisis yang terdiri dari 12 penelitian dengan total 693 pasien yang membandinglan kejadian suplementasi analgesia intraoperatif pada seksio sesarea antara kelompok low dose (≤ 8 mg ) vs bupivakain conventional dose (>8mg). Dosis bupivakain yang digunakan pada 12 penelitian ini beragam antara 4-12,5mg.…”