Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: a prospective double-blinded randomized trial

Onishi, Eiko; Murakami, Mamoru; Hashimoto, Keiji; Kaneko, Miho

doi:10.1016/j.ijoa.2017.04.001

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…However, sample sizes in comparable studies, also focusing on use of a combination of intrathecal opioids in CS, ranged from 20 to 31 patients per group. [ 10 , 25 – 28 , 45 ] Moreover, most studies assessing intraoperative analgesia after addition of spinal fentanyl in CS have used groups containing as few as 5 to 20 patients, [ 6 – 8 , 33 , 35 , 36 , 50 ] and very few have included greater numbers of patients (29 per group). [ 9 , 10 ]…”

Section: Discussionmentioning

confidence: 99%

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

et al. 2017

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“…Control GDFT BioMed Research International supplementation. This dose was selected based on our institutional database, and it was close to the effective dose for 95% of single-shot spinal anesthesia [20,21]. Consequently, only three of the participants (3.75%) exhibited a sensory blockade below T 6 .…”

Section: Groupmentioning

confidence: 99%

Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

Yang

Lin

Lee

et al. 2021

BioMed Research International

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Background. Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method. In total, 71 consecutive full-term pregnant women were randomly divided into a control group ( n = 34 ) and a GDFT group ( n = 37 ). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result. Women in the GDFT group received more fluid than did those in the control group ( 1132 ± 108 vs. 1247 ± 202 mL; p = 0.0044 ), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864 ) and norepinephrine dose ( 12.5 ± 10.6 vs. 15.1 ± 12.8 mcg, respectively; p = 0.3512 ) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332 ). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion. ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

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“…The intrathecal dose of hyperbaric bupivacaine effective in 95% (ED95) of spinals for caesarean section has been established to be 11.2 mg [4], 0.06 mg/cm of height [5], or even more recently 12.6 mg of hyperbaric bupivacaine [6].…”

Section: Introductionmentioning

confidence: 99%

Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

Białowolska¹,

Horosz²,

Sękowska³

et al. 2020

JCM

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The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9–13 mg) with fentanyl. Sensory block ≥ T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p > 0.05). Eight spinals in each group failed to produce a block ≥ T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block ≥ T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

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Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: a prospective double-blinded randomized trial

Cited by 16 publications

References 21 publications

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

Perioperative analgesia after intrathecal fentanyl and morphine or morphine alone for cesarean section

Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

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