Abstract
The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5%) according to the height and weight of patients (Group AD) from Harten's dose chart developed from the Caucasian parturients and the fixed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a significantly (p < 0.05) larger number of patients 12 (24%) in Group FD than in one (2%) patient in Group AD. A significantly (p < 0.05) larger number of patients, 32, (64%) in Group FD had hypotension than in 15 (30%) patients in Group AD. The lowest recorded SAP (101 +/- 6 mm Hg) in Group AD was higher than in Group FD (96 +/- 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. The bupivacaine dose was significantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fixed compared with the dose use.
Highlights
The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section
After approval of the study by the Ethics Committee of the institute and obtaining a written informed consent from the mothers, patients in the criterion of the American Society of Anesthesiologists’ Physical Status I and II9 With full term uncomplicated singleton gestation scheduled for elective caesarean delivery under spinal anesthesia were enrolled in the study
The two study groups were similar in terms of patient characteristics, blood loss, duration of surgery and baseline systolic arterial pressure (SAP) (Table 2)
Summary
The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. One of the important methods to reduce haemodynamic changes would be to limit wide spread sympathetic block during spinal anesthesia. This can be achieved by restricting the spinal segment block desired for a caesarean section. The aim of our study was to compare the spinal blockade characteristics, maternal adverse effects and neonatal outcome between adjusted versus fixed dose regimen in women undergoing cesarean section in our university hospital, the BP Koirala Institute of Health Sciences
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