Small dose spinal bupivacaine for Cesarean delivery does not reduce hypotension but accelerates motor recovery

Abstract

Intrathecal bupivacaine 4.5 and 12 mg yielded similar sensory block and side effects during Cesarean delivery. Patients receiving 4.5 mg did, however, experience significantly less motor blockade of shorter duration.

Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism

“…9,10 Successful CSE, epidural, and spinal anesthesia were achieved in our study population, yet the doses used were generally lower than those used in parturients of normal stature. [22][23][24] Given that adequate anesthesia was achieved in some patients with intrathecal bupivacaine 6.75-8.25 mg and epidural lidocaine 40-60 mg, it may be prudent to initiate anesthesia using a lowdose spinal as part of a combined spinal-epidural technique or to titrate epidural anesthesia slowly in order to avoid inadequate anesthesia or high blockade with single-shot spinal anesthesia.…”

Evidence-Based Obstetric Anesthesia: An Update on Anesthesia for Cesarean Delivery

“…The anesthesiologist should consider whether adjuvant drugs will be used and whether the risks of giving supplemental analgesia or conversion to general anesthesia that are associated with low doses of bupivacaine outweigh the potential benefits (i.e., less hypotension, faster recovery) [53][54][55][56][57]. For a single-shot spinal anesthesia for cesarean delivery, most anesthesiologists use a dose of bupivacaine between 10 and 15 mg, in combination with opioids, sufentanil or fentanyl and morphine.…”

“…However, a satisfactory block has been reported with plain bupivacaine drug doses as low as 4.5 mg [57]. Nonetheless, the CSE technique may use a lower dose of spinal bupivacaine (7.5 to 10 mg) followed by incremental injection of local anesthetic through the epidural catheter to achieve a T4 level of anesthesia [43,44], a procedure called sequential CSE.…”

Challenges in obstetric anesthesia and analgesia

“…16 Anesthesiologists are investigating many aspects of anesthetic technique for Cesarean delivery in order to reduce the high incidence of hypotension with spinal anesthesia at Cesarean delivery. Practices that have been investigated include: using low dose spinal bupivacaine with relatively high dose fentanyl 17 or a combined spinal-epidural technique; 18 varying the speed of injection; 19 administering vasopressors prophylactically, 15,20,21 and providing fluid loading. 21 More sophisticated models have been proposed, such as using baseline heart rate 22 or heart rate variability 23 to anticipate hypotension, or dural sac dimensions to predict spread of local anesthetic.…”