Use of hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section

Sia, Alex Tiong Heng; Tan, Kok Hian; Sng, Ban Leong; Lim, Yong Kuei; Chan, Edwin Sy; Siddiqui, Fahad Javaid

doi:10.1002/14651858.cd005143.pub2

Cited by 20 publications

(16 citation statements)

References 13 publications

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“…Spinalanesthesia (SA) allows for an effective intraoperative anaesthesia with good surgical conditions for surgeries on the lower abdomen, pelvis, lower extremity and perianal areas.SA is performed by injecting a local anaesthetic (LA) into the cerebrospinal fluid(CSF) in the subarachnoid space. This produces a rapid onset, intense, sensory and motor blockade, as well as sympathetic (20). On the other hand, IB has been found to produce a longer duration of SA (21,22).…”

Section: Discussionmentioning

confidence: 99%

The lower effective dose of isobaric bupivacaine spinal anesthesia with least level motor block for perianal surgery

Ghafoori¹,

Ahmed²

2017

Int. J. Adv. Res. Biol. Sci.

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*Background and objective:Spinal anesthesia is type of regional neuraxial anesthesia that is used for lower abdominal, lower limb, and perianal surgeries. The aim of this study is to evaluate the lower effective isobaric bupivacaine dose in spinal anesthesia for perianal surgery that produces the least level motor blockade. * Patients and methods: Fifty-seven patients were enrolled in this study in Baqubah Teaching Hospital between 10 th of February 2017 to 15 th of September of the same year, all of them underwent perianal surgeries under spinal isobaric bupivacaine anesthesia. They were classified into three groups according to isobaric bupivacaine dose from 10 mg (2 ml) to 5 mg (1 ml) by decreasing 2.5 mg (0.5 ml) in each group. Lumbar puncture was done at the L4-L5/L5-S1 midline intervertebral space with spinal needle G22 Quincke type and isobaric bupivacaine dose was injected in sitting position then immediately turned the patient to supine positioin. A successful block was defined as one that was sufficient to proceed with surgery without any supplementation other than premedication. *Results: Different doses of isobaric bupivacaine spinal anesthesia result in different levels of spinal blockade(sensory and motor) which proportionates directly to the dose, while 10 mg isobaric bupivacaine causes spinal blockade up to T12 dermatome, 5 mg dose causes blockade just to L3 dermatome in most cases. 5 mg isobaric bupivacaine spinal anesthesia provides adequate surgical analgesia , good muscle relaxation, absence of reflexes to surgical stimuli with least level motor spinal block over sacral nerves that innervate perianal area. Conclusion: 5 mg isobaric bupivacaine is the lower effective dose in spinal anesthesia that provides good operating conditions, rapid recovery, early discharge, no postoperative anesthetic complications with most lower level motor blockade.

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Section: Discussionmentioning

confidence: 99%

The lower effective dose of isobaric bupivacaine spinal anesthesia with least level motor block for perianal surgery

Ghafoori¹,

Ahmed²

2017

Int. J. Adv. Res. Biol. Sci.

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“…Cependant, même si l'installation de l'anesthésie est correcte avec l'emploi d'une DE 50, l'anesthésie ne couvre parfois pas toute la durée de l'intervention. Une méta-analyse a comparé l'utilisation de bupivacaïne hyperbare et isobare et met en évidence une plus grande rapidité d'installation et un moins grand besoin de recours à l'AG et à la supplé-mentation avec la forme hyperbare [26]. Un autre travail étudie la séquence d'injection de 5 mg de bupivacaïne isobare suivie de 5 mg d'hyperbare dans l'objectif d'assurer un bloc moteur pour les dermatomes inférieurs et un bloc sensitif et sympathique moins haut [27].…”

Section: Réalisation Pratique De La Raunclassified

Anaesthesia for caesarean delivery: Main methods and indications

2016

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Comme toute intervention chirurgicale, la césa-rienne nécessite la réalisation d'une anesthésie et l'application de sa réglementation. L'anesthésie locorégionale est la technique de référence pour les situations non urgentes et semi-urgentes et comporte la rachianesthésie, la rachianesthésie avec péridurale combinée et l'anesthésie péridurale. L'anesthésie générale, pourvoyeuse d'une forte morbimortalité maternelle, reste réservée aux situations bien particulières de la césarienne en urgence et aux contre-indications de l'anesthésie locorégionale.Mots clés Césarienne · Anesthésie générale · Rachianesthésie · Rachianesthésie avec péridurale combinée · Anesthésie péridurale Abstract As for any surgical procedure, caesarean delivery requires anaesthesia and the application of related regulations. Regional anaesthesia is the reference technique for elective or semi urgent caesarean delivery and includes spinal anaesthesia, combined spinal epidural anaesthesia and epidural anaesthesia. General anaesthesia may be associated with severe maternal morbidity and mortality and is mainly used for emergency caesarean delivery or when regional anaesthesia is contra-indicated.

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“…When hyperbaric and isobaric forms of bupivacaine were compared, rate of conversion to general anesthesia was significantly less and time to achieve sensory block at T4 was significantly faster with hyperbaric bupivacaine than that of isobaric bupivacaine [2]. Different dose selections are made based on either dose response studies (ED95 or ED50) or clinical experiences.…”

Section: Short Communicationmentioning

confidence: 99%

“…Local anesthetic options are bupivacaine, ropivacaine or levobupivacaine. If baricity is taken into account, hyperbaric bupivacaine seems to be the superior for intrathecal use according to systematic reviews [2]. Although hyperbaric bupivacaine which is commercially available is the widely used intrathecal local anesthetic, prepared hyperbaric ropivacaine when used intrathecally as part of CSE technique might be suitable for cesarean delivery [7,12].…”

Section: Short Communicationmentioning

confidence: 99%

Which Local Anesthetic at what Dose is Recommended for Parturients Undergoing Cesarean Delivery Under Spinal Anesthesia?

Günaydın¹,

Tan²

2016

J Anesth Clin Res

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Spinal anesthesia is the most popular regional anesthesia technique for cesarean delivery as it is easily performed and provides rapid onset of block followed by dense surgical anesthesia. Although bupivacaine seems to be widely and routinely used long acting amide type local anesthetic drug for spinal anesthesia, ropivacaine and levobupivacaine may occasionally be chosen. However, it is difficult to make decision of the best local anesthetic for intrathecal use with optimal dose selection. Therefore, either hyperbaric or isobaric long-acting local anesthetic (bupivacaine, ropivacaine and levobupivacaine) option associated with pharmacological or clinical dose recommendations are reviewed.Keywords: Spinal anesthesia; Cesarean delivery; Local anesthetics; Dose response Short CommunicationAnesthesia choices for cesarean delivery include general, epidural, spinal or combined spinal epidural (CSE) anesthesia. According to ASA practice guidelines for obstetric anesthesia, induction to delivery times for general anesthesia are lower when compared to epidural or spinal anesthesia and rate of maternal hypotension due to epidural or spinal techniques are greater than general anesthesia. Results of metaanalysis demonstrate that Apgar scores at 1 and 5 minutes are lower with general anesthesia when compared to epidural and spinal anesthesia. As expected, time to skin incision with general anesthesia is shorter than either epidural or spinal anesthesia. But general anesthesia has increased risk of maternal complications associated with difficult airway and/or aspiration. When spinal and epidural anesthesia are compared, induction to delivery times are shorter for spinal anesthesia. However, epidural anesthesia does not result in increased risk of maternal complications like general anesthesia does [1]. Currently, single shot spinal anesthesia using local anesthetics with or without opioids has been the world wide preferred anesthetic technique for most of the elective cesarean section (CS) operations.Bupivacaine is mostly a routine option for cesarean deliveries under spinal anesthesia. When hyperbaric and isobaric forms of bupivacaine were compared, rate of conversion to general anesthesia was significantly less and time to achieve sensory block at T4 was significantly faster with hyperbaric bupivacaine than that of isobaric bupivacaine [2]. Different dose selections are made based on either dose response studies (ED95 or ED50) or clinical experiences. Of note, rational dose for intrathecal use of local anesthetics are ED95 or ED50. ED50 is called as median effective dose and regarded as minimum local anesthetic dose (MLAD). ED95 dose is recommended to achieve surgical anesthesia with a 5 % failure rate for surgical anesthesia [3,4]. According to dose response studies, ED95 of intrathecal dose of hyperbaric and isobaric bupivacaine when used with fentanyl (10 µg) and morphine (200 µg) to provide successful surgical anesthesia for cesarean delivery was found to be 11.2 mg and 13 mg, respectively [4,5]. There are two...

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Use of hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section

Cited by 20 publications

References 13 publications

The lower effective dose of isobaric bupivacaine spinal anesthesia with least level motor block for perianal surgery

The lower effective dose of isobaric bupivacaine spinal anesthesia with least level motor block for perianal surgery

Anaesthesia for caesarean delivery: Main methods and indications

Which Local Anesthetic at what Dose is Recommended for Parturients Undergoing Cesarean Delivery Under Spinal Anesthesia?

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