Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial

Teoh, Wendy H.; Thomas, E.; Tan, Hsiao Ming

doi:10.1016/j.ijoa.2006.03.004

Cited by 50 publications

(49 citation statements)

References 14 publications

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“…More recently Van de Velde et al [4] demonstrated that the incidences of hypotension with 9.5 mg and 6.5 mg intrathecal bupivacaine were 68% and 16%, respectively. Teoh et al [5] also reported that hypotension occurred at incidences of 73% and 14% with 9 mg and 3.75 mg intrathecal bupivacaine, respectively. The prevention and treatment of maternal hypotension associated with spinal anesthesia for cesarean section remains a diffi cult problem, with no consensus as to the optimal mode of management.…”

Section: Discussionmentioning

confidence: 96%

Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?

2009

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Section: Discussionmentioning

confidence: 96%

Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?

2009

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“…18 Teoh et al demonstrated significantly lower incidence of maternal hypotension with the use of ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery. 19 He concluded that it has a good role in high-risk patients in whom maintenance of stable hemodynamics is imperative. It was found that small dose of spinal bupivacaine when dissolved in large volume, it got diluted.…”

Section: Discussionmentioning

confidence: 99%

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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INTRODUCTIONCombined spinal-epidural anesthesia (CSEA) is gaining popularity as preferred technique for caeserean sections and orthopaedic surgeries as it has rapid onset through spinal component and extension of aneasthesia and postoperative pain relief through epidural component while avoiding disadvantage of both. [1][2][3] Epidural volume extension (EVE) is a modification of CSEA in which fluid is injected in epidural space through epidural catheter after intrathecal spinal block. The epidural space with colloids, which compress the subarachnoid space, causes cephalic spread of intrathecal local anaesthetic to increase block height and speed of onset (Volume Effect). 1,4 In contrast EVE with local anaesthetic causes leaks from epidural space to subarachnoid puncture and also perineural or transdural spread of the extradural solution to enhance intensity and block duration besides volume effect. [5][6][7] In this study, we aimed to evaluate the efficacy of epidural volume extension (EVE) with colloid on dose requirement of intrathecal bupivacaine with fentanyl to ABSTRACT Background: Epidural volume extension (EVE) is a modification of combined-spinal epidural anaesthesia (CSEA) in which fluid is injected in epidural space after the intrathecal block. Fluid in epidural space compress subarachnoid space and causes cephalic spread of intrathecal drug to increase block height. Purpose of study is to determine efficacy of EVE on dose requirement of intrathecal bupivacaine when colloid was used for EVE. Methods: Sixty patients of ASA physical status I or II, scheduled for elective caesarean sections were recruited and randomized into two groups (30 each group). Group 1: CSEA in which spinal block is followed by 10 ml Colloid (HES 6%) in epidural space; Group 2: CSEA but no fluid in epidural space. Onset of sensory block and hemodynamic variables were measured at 5 min. intervals up to 40 minutes then at 10 min. intervals till end of surgery. Ineffective block was top-up by epidural 0.5% bupivacaine in incremental doses. Results: Median effective dose of intrathecal bupivacaine was significantly lower, 4.0 mg (95% CI 4.40-5.60) in group 1 versus 7.0 mg (95% CI 6.93-7.61) in group 2. Only 11 patients required ephedrine in group 1 versus 20 in group 2. Requirement of ephedrine was significantly lower 2.20 (±2.94) mg in group 1 versus 4.0 (±2.88) mg groups 2. Changes in haemodynamic variables from baseline were significantly lower in group 1 than those in group 2. Conclusions: EVE with colloid was effective in lowering dose requirement of spinal bupivacaine while patients hemodynamically were more stable.

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“…Values are presented as means ± SD or medians (ranges) There were no signifi cant differences between the groups from 10 to 25 µg [8][9][10][11][12]. Within the recommended dose range, treatment of pruritus resulting from higher doses of intrathecal fentanyl is likely to be of benefi t when 5HT 3 receptor antagonists are used.…”

Section: Discussionmentioning

confidence: 99%

Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus

et al. 2007

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Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean delivery: a randomized controlled trial

Cited by 50 publications

References 14 publications

Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?

Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus

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