Comparison of 9 mg of Intrathecal Plain and Hyperbaric Bupivacaine Both with Fentanyl for Cesarean Delivery

A Comparison of Spinal Anesthesia with Levobupivacaine and Hyperbaric Bupivacaine for Cesarean Sections: A Randomized Trial

“…In our study also, sensory and motor block durations were found to be shorter in the levobupivacaine group. The effects of baricite on the block characteristisc have been contradictory in literature: while some studies that report the difference in baricite does not affect block charecteristics [22] on the one hand, there are also studies reporting that motor block develops and disappears faster when hyperbaric solutions are used [23] on the other hand. Therefore we cannot ascribe the difference of sensory and motor block between the two groups in our study to the difference of baricite only.…”

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

“…4,[18][19][20] However, their findings depend on the doses and volumes used. It may not be valid to compare directly these studies with our research.…”

“…and Sarvela et al used a similar dose and volume (10 mg and 9 mg in 2 mL, respectively) to our total dose, both used doses and volumes nearly twice that of our plain bupivacaine dose and volume. 4,20 Our plain and hyperbaric doses and volumes must be separately assessed, because each acts differently according to their dynamic properties. Small-volume low-dose plain bupivacaine, such as 5 mg in 1 mL used in our study, may result in more restricted spread than 9-15 mg in 2-2.5 mL solution, used in previous studies.…”

“…When using larger volumes and doses, previous studies have reported a high incidence of hypotension regardless of baricity (44%-87%) with frequent nausea (13-44%) despite the use of prophylactic ephedrine. 4,[18][19][20] Vercauteren et al used a combination of sufentanil 3.3 lg with plain or hyperbaric bupivacaine 6.6 mg in 2 mL for spinal anesthesia as part of a combined spinal-epidural procedure in cesarean section. 21 In their study, individual variability was pronounced in the plain group, and significantly more patients in the plain group had blocks that were either too high or too low.…”

“…1 However, a level of anesthesia up to and including T5 is required to prevent intraoperative discomfort and visceral pain during surgery, [2][3][4] and the risk of hypotension by rapid onset of sympathetic blockade under such high and dense spinal anesthesia remains a major concern.…”