Two doses of spinal bupivacaine for caesarean delivery in severe preeclampsia: a pilot study

Jain, Kajal; Makkar, Jeetinder Kaur; Yadanappudi, S.; Anbarasan, Iswarya; Gander, Shalini

doi:10.1016/j.ijoa.2011.12.010

Cited by 9 publications

(10 citation statements)

References 7 publications

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“…Previous studies showed that lowering the spinal dose of local anesthetics could reduce the incidence of maternal hypotension for patients undergoing cesarean delivery. [ 15 28 29 30 31 32 ] The different finding in the present study may be related to the small sample size, and further study about intrathecal dose relevant hypotension of ropivacaine is needed.…”

Section: Discussionmentioning

confidence: 67%

The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Xiao

Xu²,

Zhang³

et al. 2015

Chinese Medical Journal

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Background:Spinal anesthesia is considered as a reasonable anesthetic option in lower abdominal and lower limb surgery. This study was to determine the dose-response of intrathecal ropivacaine in patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia.Methods:Seventy-five patients with scarred uterus undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this randomized, double-blinded, dose-ranging study. Patients received 6, 8, 10, 12, or 14 mg intrathecal hyperbaric ropivacaine with 5 μg sufentanil. Successful spinal anesthesia was defined as a T4 sensory level achieved with no need for epidural supplementation. The 50% effective dose (ED50) and 95% effective dose (ED95) were calculated with a logistic regression model.Results:ED50 and ED95 of intrathecal hyperbaric ropivacaine for patients with scarred uterus undergoing cesarean delivery under combined spinal-epidural anesthesia (CSEA) were 8.28 mg (95% confidence interval [CI]: 2.28–9.83 mg) and 12.24 mg (95% CI: 10.53–21.88 mg), respectively.Conclusion:When a CSEA technique is to use in patients with scarred uterus for an elective cesarean delivery, the ED50 and ED95 of intrathecal hyperbaric ropivacaine along with 5 μg sufentanil were 8.28 mg and 12.24 mg, respectively. In addition, this local anesthetic is unsuitable for emergent cesarean delivery, but it has advantages for ambulatory patients.

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Section: Discussionmentioning

confidence: 67%

The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Xiao

Xu²,

Zhang³

et al. 2015

Chinese Medical Journal

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“…Ropivacaine has the advan- Figure 1. The changes of systolic blood pressure between Rupivacaine and Bopivacaine groups tage of separated sensory and motor block, with less toxicity to the cardiovascular system and central nervous system (22)(23)(24). Some studies have shown that ropivacaine is more effective in sensory and motor block being inferior to the lidocaine but superior to the bupivacaine (25).…”

Section: Discussionmentioning

confidence: 99%

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

et al. 2020

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Background: Spinal anesthesia is the most common technique used for cesarean delivery due to some advantages compared to regional anesthesia. It is easily performed and provides a rapid onset of block. Though bupivacaine is a generally used long-acting amide type local anesthetic drug for spinal anesthesia, ropivacaine may sometimes be selected. Objectives: This prospective, randomized, double-blinded study was aimed at comparing clinical efficacy and safety between ropivacaine and bupivacaine during cesarean section. Methods: After getting ethical committee approval and written informed consent, 65 women who referred to Imam Khomeini Hospital of Ahvaz, Iran in 2018 were chosen for elective cesarean delivery under spinal anesthesia. They were randomly allocated to receive either ropivacaine 1% (n = 33) or bupivacaine 0.5% (n = 32). Afterwards, the differences in the anesthetic efficacy, vital signs, and hemodynamics of participants between the two groups were recorded. Results: Duration of sensory block was shorter in the ropivacaine group than bupivacaine group (132.5 ± 21.6 min vs. 175.8 ± 26.2 min; P < 0.001). Ropivacaine also produced a shorter duration of motor blockade than bupivacaine (124.8 ± 20.2 min vs. 168.2 ± 21.7 min; P < 0.001). There is no difference between the two groups in terms of systolic and diastolic blood pressure, but the heart rate of patients in the bupivacaine group is significantly higher than the ropivacaine group. Conclusions: The results suggest that ropivacaine and bupivacaine are two efficient drugs in anesthesia in the cesarean section, ropivacaine is a better choice due to little influence on the hemodynamics and shorter duration of sensory block and motor block which are useful for the recovery and also safe to the patients.

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“…[ 21 ] Therefore, reducing or avoiding spinal-induced hypotension is a focus task while we choose spinal anesthesia for patients with severe preeclampsia. A recent study suggested that lower intrathecal bupivacaine (7.5 mg vs. 10 mg, when coadministered with fentanyl 20 μg) offered more stable hemodynamic level in severely preeclamptic patients,[ 7 ] then a reduction of intrathecal local anesthetic was advised to reduce spinal-induced hypotension for these patients. [ 3 ] However, an ideal effective dose of intrathecal bupivacaine for cesarean section in severe preeclampsia patients has not been determined and quantified so far.…”

Section: Discussionmentioning

confidence: 99%

“…Limiting the dose of spinal, local anesthetics for caesarean delivery has been advocated for decreasing the incidence of spinal-induced hypotension in both normal intensive parturients and preeclamptic parturients. [ 4 5 6 7 ] Moreover, a reduction in spinal, local anesthetics may be achieved by a small dose of spinal opioid. Sufentanil, which is a more lipophilic opioid with a higher affinity to opioid receptors, a much higher analgesic potency than fentanyl or morphine,[ 8 9 10 ] has been shown to produce synergistic effects with local anesthetics, consequently to reduce spinal local anesthetics doses.…”

Section: Introductionmentioning

confidence: 99%

ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

Xiao

Xu²,

Zhang³

et al. 2015

Chinese Medical Journal

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Background:Spinal anesthesia was considered as a reasonable anesthetic option in severe preeclampsia when cesarean delivery is indicated, and there is no indwelling epidural catheter or contraindication to spinal anesthesia. However, the ideal dose of intrathecal bupivacaine has not been quantified for cesarean delivery for severe preeclamptic patients. This study aimed to determine the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery.Methods:Two hundred severely preeclamptic patients are undergoing elective cesarean delivery under combined spinal-epidural anesthesia enrolled in this randomized, double-blinded, dose-ranging study. Patients received 4 mg, 6 mg, 8 mg, or 10 mg intrathecal hyperbaric bupivacaine with 2.5 μg sufentanil. Successful spinal anesthesia was defined as a T6 sensory level achieved within 10 minutes after intrathecal drug administration and/or no epidural supplement was required during the cesarean section. The ED50 and ED95 were calculated with a logistic regression model.Results:ED50 and ED95 of intrathecal bupivacaine for successful spinal anesthesia were 5.67 mg (95% confidence interval [CI]: 5.20–6.10 mg) and 8.82 mg (95% CI: 8.14–9.87 mg) respectively. The incidence of hypotension in Group 8 mg and Group 10 mg was higher than that in Group 4 mg and Group 6 mg (P < 0.05). The sensory block was significantly different among groups 10 minutes after intrathecal injection (P < 0.05). The use of lidocaine in Group 4 mg was higher than that in other groups (P < 0.05). The use of phenylephrine in Group 8 mg and Group 10 mg was higher than that in the other two groups (P < 0.05). The lowest systolic blood pressure before the infant delivery of Group 8 mg and Group 10 mg was lower than the other two groups (P < 0.05). The satisfaction of muscle relaxation in Group 4 mg was lower than other groups (P < 0.05). There was no significant difference in patients’ satisfaction and the newborns’ Apgar score and the blood gas analysis of umbilical artery serum (P > 0.05).Conclusion:Our study showed that the ED50 and ED95 of intrathecal bupivacaine for severely preeclamptic patients undergoing elective cesarean delivery were 5.67 mg and 8.82 mg, respectively. In addition, decreasing the dose of intrathecal bupivacaine could reduce the incidence of maternal hypotension.

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Two doses of spinal bupivacaine for caesarean delivery in severe preeclampsia: a pilot study

Cited by 9 publications

References 7 publications

The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

The Dose-response of Intrathecal Ropivacaine Co-administered with Sufentanil for Cesarean Delivery under Combined Spinal-epidural Anesthesia in Patients with Scarred Uterus

Comparing the Effect of Bupivacaine and Ropivacaine in Cesarean Delivery with Spinal Anesthesia

ED50 and ED95 of Intrathecal Bupivacaine Coadministered with Sufentanil for Cesarean Delivery Under Combined Spinal-epidural in Severely Preeclamptic Patients

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