Abstract
Background: Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. But there is a dosage dilemma regarding block to the desired level and preventing hypotension. We aim to study effects of fixed dose with height and weight-adjusted dose of intrathecal 0.5% hyperbaric bupivacaine during elective cesarean section.
 Methods: Eighty-eight singleton term parturients were enrolled and divided into two groups, Group FD (Fixed Dose) and CD (Calculated Dose) in this prospective, double-blind, randomized controlled trial. Group FD received 2.2 ml and CD received a height and weight adjusted calculated dose based on Harten's chart. Hemodynamic changes, onset time to sensory block to T6, maximum block in 20 minutes, and adverse effects were compared.
 Results: There was a significant reduction in median drug dosage of 11mg in FD versus 9 mg in CD group. The decrease in the MAP was less in group CD (14.5±2.98) mmHg compared to (17.6±4.66) mmHg in group FD (P= 0.03). The median onset time of spinal block to T6 in group FD of 2 minutes with IQR (2-3) was faster than Group CD 4 minutes with IQR (3-5). The spinal block extended above T4 in the larger number of parturients 23 (52 %) in Group FD than in three (6.8%) in group CD (p<0.05). Significantly larger number 20 (45.45 %) in group FD developed hypotension than seven (15.9 %) in Group CD. Bradycardia and vomiting were also found in group FD.
 Conclusions: This calculated dose provided the desired level of the spinal block and also restricted spinal block level with a distinct advantage of less hypotension.
Highlights
Spinal anesthesia with hyperbaric bupivacaine is the preferred anesthetic technique for cesarean deliveries1.The incidence of hypotension following spinal anesthesia for cesarean section is high with trials reporting as high as 80%
A total of 88 parturient of singleton term gestation, American Society of Anesthesiologists physical status (ASA-PS) class II planned for the elective cesarean section and the combination of height and weight falling in Harten’s chart were included
Nagata et al15 found that 8 mg of 0.5% Hyperbaric Bupivacaine in SAB was adequate for cesarean section in Japanese parturient
Summary
Spinal anesthesia with hyperbaric bupivacaine is the preferred anesthetic technique for cesarean deliveries.The incidence of hypotension following spinal anesthesia for cesarean section is high with trials reporting as high as 80%.2. The preventive measures decrease the incidence and severity of adverse effects rather than treating hypotension once it is established, there is no established ideal technique. The dose adjustment study is based on a Caucasian population whose built differs from that of our population but still, we used it to compare the effects on the ground of hemodynamics, block characteristics and adverse effects. We aim to study effects of fixed dose with height and weightadjusted dose of intrathecal 0.5% hyperbaric bupivacaine during elective cesarean section. The median onset time of spinal block to T6 in group FD of 2 minutes with IQR (2-3) was faster than Group CD 4 minutes with IQR (3-5). The spinal block extended above T4 in the larger number of parturients 23 (52 %) in Group FD than in three (6.8%) in group CD (p
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