A comparative study of low dose Bupivacaine vs high dose Bupivacaine along with Fentanyl and Phenylephrine on Pregnant women undergoing elective Caesarean Section under Spinal Anesthesia

A Sivaram, Govardhani Y, Varaprasad U S S A

Abstract


Background :This randomized study was conducted to evaluate the effect of low dose vs high dose Bupivacaine+Fentanyl, with or without Phenylephrine infusion on hemodynamics, motor recovery, adequacy of block and side effects, on pregnant  women undergoing caesarean section under spinal anaesthesia. Methods: One hundred sixty pregnant  women were randomized into four groups of fourty each. Group-A (n=40) received 10 mg(2ml) of Bupivacaine + Fentanyl 25µg(0.5ml) along with Phenylephrine i.v. infusion of 0.25µg/Kg/min. Group-B (n=40) recieved same drugs, without Phenylephrine infusion. Group-C (n=40) received 7 mg(1.4ml) of Bupivacaine+Fentanyl 25µg(0.5ml) along with Phenylephrine i.v. infusion of 0.25µg/Kg/min. Group-D (n=4) received same drugs , without Phenylephrine infusion. Result:  When given with fentanyl,  low dose bupivacaine (1.4 ml / 7 mg) was as effective as of high dose buypivacaine (2ml/ 10mg) in producing adequate relaxation and analgesia. Addition of low dose phenylephrine infusion decreased the incidence of hypotension maintains the pulse rate nearer to baseline for better hemodynamic stability. The motor recovery was quick in case of low dose bupivacaine groups with or without phenylephrine which aids in early mobilization of pregnant women. Conclusion: When given along with an opioid like fentanyl, low dose bupivacaine (1.4 ml / 7 mg) was as effective as of high dose buypivacaine (2ml/ 10mg) in producing adequate relaxation and analgesia. Addition of low dose phenylephrine infusion decreased the incidence of hypotension and maintained better hemodynamic stability

Full Text:

PDF HTML

References


Ben David et al. Intrathecal fentanyl with small dose bupivacaine, better anesthesia without prolonging recovery. Anesth analg , 1997;85;560-565.

Chu C.et.al : The effect of intrathecal bupivacaine with combined fentanyl in cesarean section. Acta Ana- esthesiol sin.1995; 33: 149–I54

Dahlgren G.et. al: Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Obstet Anesth.1997; 85: 1288–1293.

Hamber E. A., Viscomi C. M. : Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth; 1999.24: 255–263

MarcVandevelde et.al : Dose dependent effects of hyperbaric bupivacaine on maternal hemodynamics for Caessarean sectin deliveries.. Anesth Anal 2006;103:187 – 90.

Eldrid langesaeter, Leiv arne Rosseland, A Randomized, Double blind comparison of low dose versus High dose spinal Anesthesia with Intravenous phenylephrine or placebo Infusion Anesthesiology 2008; 109: 856 – 863.

Ngan Kee W.D: Prophyactic phenylephrine infusion for preventing Hypotension during Anesthesia for cesarean Delivery Anesth Analg 2004; 815 – 82.

Aya AG M, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, et al Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: A prospective cohort comparison. Anesth Analg 2003;97:867-72

Aya AGet al.Spinal anesthesia-induced hypotension between patients with severe preeclampsiaand healthy women undergoing preterm cesarean delivery.Anesth Analg 2005;101:869-75.

Visalyaputra et.al. Spinal versus epidural anesthesia for caesarean section in severe preeclampsia: A prospective randomized, multicentre study. Anesth Analg 2005;101:862-8.

Tejwani GA etal. Role of spinal opioid receptors in the antinociceptive interactions between intrathecal morphine and bupivacaine. Anesth Analg 1992; 74:726-734.

Langesater E, Rosseland LA, Stubhaug A. Continuous invasive bloodpressure and cardiac output monitoring during cesarean delivery: A randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion.Anesthesiology 2008;109:856-63.

Cooper et al. Evidence that intravenous vasopressors can affect rostral spread of spinal anaesthesia in pregnancy Anaesthesiology 2004;101:28-33.

Lee A, Ngan Kee WD, Gin T. A quantitative systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean section. Anesth Analg 2002; 94: 920±6

Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM,Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.Anesthesiology 2002; 97: 1582-90

Anna Lee, Ngan Kee W.D : A quantitative systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of Hypotension during spinal Anesthesia for cesarean Delivery Anesth Analg 2002;94:920-926.

David W.Cooper, Fetal and Maternal Effects of phenylephrine and ephedrine during spinal Anesthesia for cesarean delivery Anesthesiology 2002;97:1582 – 1590.

Jain K, Grover VK, Mahajan R, Batra YK. Eff ects of varying doses of fentanyl with low dose spinal bupivacaine for caesarean delivery in patients with PIH. Int J Obstet Anesth 2004;13:215-20.

Ramanathan J, Vaddadi AK, Arrear KL. Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: A preliminary report. Reg Anesth Pain Med 2001;26:46-51.

McNaught AF, Stocks GM. Epidural volume extension and low-dose sequential combined spinal-epidural blockade: Two ways to reduce spinal dose requirement for caesarean section. Int J Obstet Anesth 2007;16:346-53.

Teoh WH, Sia AT. Ultra-low dose combined spinal-epidural anaesthesia caesarean section in severe preeclampsia. Anaesthesia 2006;61:511-2.

Rooft hooft E, Van de Velde M. Low-dose spinal anaesthesia for caesarea section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol 2008;21:259-62.

Birbbach DJ, Browne IM. Anesthesia of Obstretics In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL et al. editors. Miller’s Anesthesia. 7th ed. USA: Churchill-Livingston Elsevier; 2010:2203-40.

Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 1983;249:1743-5.

Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single shot spinal anesthesia for elective cesarean delivery. Int J Obstet Anesth 2006;15:13-7.

Van de Velde M, Van Schoubroeck D, Jani J, Teunkens A, Missant C, Deprest J. Combined spinal epidural anesthesia for Cesarean section: Dose dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg 2006;103:187-90.

Wiebke Gogarten. Preclampsia and anesthesia.Curr Opin Anesthesiol 2009;22:347-51


Refbacks

  • There are currently no refbacks.