Low-Dose Bupivacaine-Fentanyl Spinal Anesthesia for Cesarean Delivery

Ben‐David, Bruce; Miller, Gabriella; Gavriel, Rahel; Gurevitch, Alexander

doi:10.1097/00115550-200005000-00005

Cited by 174 publications

(169 citation statements)

References 16 publications

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“…Pedersen et al(1989) demonstrated that increasing the dose of intrathecal local anesthetic reduced the incidence and severity of visceral pain without increasing maternal hypotension. However, many other studies found that increasing the dose of local anesthetic increased maternal hypotension (Kang et al, 1998;Ben-David et al, 2000). We found in this study that there was a dose-dependent relation between the rate of hypotension and the ropivacaine dose, whereas there was no significant difference of nausea/vomiting among the 4 groups.…”

Section: Discussioncontrasting

confidence: 42%

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

Chen

Lou

et al. 2006

J. Zhejiang Univ. - Sci. B

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Abstract:Background: Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods: Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1~L2 vertebral interspace, then lumbar puncture was performed at the L3~L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results: ED50 (95% confidence interval) of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23~11.59) mg and ED95 (95% confidence interval) to be 15.39 (13.81~23.59) mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion: The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

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Section: Discussioncontrasting

confidence: 42%

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

Chen

Lou

et al. 2006

J. Zhejiang Univ. - Sci. B

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“…In total number of top-up was 4.02 in group A and 3.96 in group B that is not significant and also total volume of epidural drug requirement in group A was 30.96 mL and 29.46 mL in group B, so there was no difference between top-up and volume of drug between two groups, which similar to the study of Choi et al and Ben Devid et al 9,10 We have found that mean total dose of bupivacaine used in group A was 30.46 mg, and in group B, it was 20.62 mg/dL, which was statistically significant, which is similar to the study of Amit G et al 11 Mean duration of labour in both the group was comparable to each other and comparatively shorter than usual, which is supported by various studies. 12,13 Both the groups have good quality of analgesia and all the cores VAS score was less than 3.…”

Section: Discussionsupporting

confidence: 79%

A Prospective Comparative Study of Combined Spinal Epidural Labour Analgesia With Intrathecal Fentanyl 25 MCG Along With Two Doses of Epidural Bupivacaine With Epidural Fentanyl 2 McG/Ml

K¹

2017

jebmh

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BACKGROUNDCombined Spinal Epidural Anaesthesia (CSEA) is frequently used for its rapid onset of analgesia and good patient satisfaction. In this group, various types of intrathecal intervention are possible.The aim of the present study has been designed to evaluate the quality of analgesia when intrathecal fentanyl 25 mcg was given along with epidural 0.0625% bupivacaine 10 cc with fentanyl 2 mcg/mL in one group in companion with another group who has been given intrathecal fentanyl 25 mcg given long with epidural 10 cc bupivacaine 0.1% with fentanyl 2 mcg/mL.

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“…(45,46) The drawback of lowering the doses (<5mg) was the increasing incidence of spinal block failures with pain, slower onset and shorter duration of the block and also the increasing rate of conversions into general anaesthesia. (42,44,47,48) In contrast to the above mentioned studies, Langesaeter et al (20) showed that there was a difference in the incidence of hypotension with the same sensory block level, but a different local anaesthetic dosage. According to the above described findings, the focus of our study was the level of spinal block as the underlying factor for the difference in haemodynamic parameters during a spinal anaesthesia excluding different doses and/ or baricities of local anaesthetic.…”

Section: Discussionmentioning

confidence: 98%

“…Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block.…”

Section: Introductionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Low-Dose Bupivacaine-Fentanyl Spinal Anesthesia for Cesarean Delivery

Cited by 174 publications

References 16 publications

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

Dose-response study of spinal hyperbaric ropivacaine for cesarean section

A Prospective Comparative Study of Combined Spinal Epidural Labour Analgesia With Intrathecal Fentanyl 25 MCG Along With Two Doses of Epidural Bupivacaine With Epidural Fentanyl 2 McG/Ml

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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