Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic stability in cesarean section

Combining Intrathecal Bupivacaine and Meperidine during Caesarean Section to Prevent Spinal Anaesthesia-Induced Hypotension and other Side-Effects

“…Low-dose plain bupivacaine was used to obtain dense anaesthesia surrounding the incision area, then administration of hyperbaric meperidine was used to suppress visceral pain. The present results were similar to those of Cesur et al: 12 in both studies, the incidence of hypotension decreased in the groups in which isobaric and hyperbaric agents were administered intrathecally in a sequential manner.…”

“…Intrathecal meperidine has, however, a narrow therapeutic window and respiratory depression -and other sideeffects, such as nausea and vomiting, pruritus and urinary retention -can occur with doses as low as 0.5 mg/kg. 10,11 Cesur et al 12 stated that the sequential administration of low doses of plain and hyperbaric bupivacaine during spinal anaesthesia reduced the incidence of hypotension, nausea and vomiting. Based on these findings, we proposed that sequential subarachnoid injections of low doses of plain bupivacaine and hyperbaric meperidine could achieve similar results.…”

“…Cesur et al 12 stated that to reduce or eliminate some of the disadvantages associated with the use of hyperbaric and isobaric spinal anaesthesia, while preserving the advantages of both, low doses (1 ml) of plain and hyperbaric bupivacaine should be administered sequentially. This regimen reduced the incidence of hypotension, when compared with the use of hyperbaric bupivacaine alone (13.9% versus 66.7%, respectively).…”

“…This regimen reduced the incidence of hypotension, when compared with the use of hyperbaric bupivacaine alone (13.9% versus 66.7%, respectively). 12 Plain bupivacaine plus hyperbaric meperidine was administered sequentially in the present study because each acts differently according to its dynamic properties. Low-dose plain bupivacaine was used to obtain dense anaesthesia surrounding the incision area, then administration of hyperbaric meperidine was used to suppress visceral pain.…”

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

“…(44) The conclusion of majority of studies was that with a lower dose of the local anaesthetic patients were more haemodynamically stable and that it was most probably the consequence of a different level of sympathetic block. (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.…”