Comparison of barbotage and single injection applied to combined spinal and epidural anesthesia in cesarean section

Abstract

Objective Comparing the outcome of barbotage(Bbt) and single injection applied to combined spinal and epidural anesthesia(CSEA) in cesarean section, including sensation block effect, motor block effect, changes of maternal hemodynamics, neonatal Apgar scores. Methods One hundred ASA Ⅱ parturients of 20-40 years with full-term pregnancy were scheduled for cesarean delivery under L2-L3 CSEA were included. They were randomly divided into 2 groups with 50 cases each group. 0.5% ropivacaine 2.2 ml(11 mg) were used in all patients. A Bbt technique was carried out in group B: 1st step, inject 1.1 ml of 2.2 ml total solution and withdrawing back to 2.1 ml, 2nd step, inject 1.1 ml of 2.1 ml solution and withdrawing back to 1.6 ml, 3rd step, inject 1.1 ml of 1.6 ml solution and withdrawing back to 1.1 ml, 4th step, inject the rest solution into subarachnoid space. The total injection time of group B is 44 s with an average speed of 0.1 ml/s. Single injection is carried out in group S within 22 s and same average speed. Dopamine and phenylephrine were used to stabilize maternal circlatory system. Record maternal blood pressure, heart rate, level of sensory block, Bromage score, usage of vasoactive drugs and local anesthetics at time of resting(t0) and 4 min(t1), 6 min(t2), 8 min(t3), 10 min(t4) min after injection. Record perioperative adverse reaction and condition of newborns. Results The speeds of block sensory level rising: group B>group S(P group S(P group S(P 0.05). Conclusions In the spinal anesthesia of cesarean section, Bbt provides wider distribution of local anesthetics in subarachnoid space, which leads to faster nerve block and higher block level with more stable blood pressure and HR. Key words: Barbotage; Ropivacaine; Combined spinal and epidural anesthesia; Cesarean section