scholarly journals The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
A Subedi ◽  
M Tripathi ◽  
BK Bhattarai ◽  
PK Gupta ◽  
K Pokharel ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Onset Time ◽  
Distinct Advantage ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Number Of Patients ◽  
Block Level ◽  
Adjusted Dose

Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section. Methods: 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 fi xed 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. Results: 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 signifi cantly (p < 0.05) larger number of patients 12 (24 %) in Group FD than in one (2 %) patient in Group AD. A signifi cantly (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. Conclusions: The bupivacaine dose was signifi cantly 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 fi xed compared with the dose use. keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.

scholarly journals Comparison of commonly used vasopressors for treating hypotension after spinal anaesthesia in elective lower abdominal surgery: a randomized, observational, case-control study

2019 ◽  
Vol 7 (5) ◽  
pp. 1479
Author(s):  
Pradeep Kumari ◽  
Sifna Tahir ◽  
Haveena Kumari ◽  
Altaf Ahmad Mir
Keyword(s):  
Blood Pressure ◽  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Time Intervals ◽  
Significant Difference ◽  
Single Bolus Dose ◽  
The Mean

Background: During caesarean section hypotension due to spinal block is secondary to the sympathetic blockade and aorto-caval compression by the uterus. It can have important consequences for the mother and may affect neonatal outcome. The present study was aimed to compare intravenous bolus doses of phenylephrine and ephedrine to treat maternal hypotension during spinal block for elective caesarean section.Methods: After fulfilling the inclusion criteria, 100 parturient were randomly allocated into two groups of fifty each. For spinal anesthesia lumber puncture was done and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally. In this observational study, patients who developed hypotension under spinal anesthesia were selected for the study. According to their group, patients received either ephedrine 6mg (Group E) or phenylephrine 75µg (Group P) as vasopressor. During the study, number of vasopressor boluses, hemodynamic response and time taken to recover from hypotension was noted.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. In 88% parturient single bolus dose of ephedrine was effective in treating hypotension while phenylephrine was effective in 78% parturient. There was no significant difference observed in total number of boluses used. No significant difference was seen in mean systolic blood pressure, mean diastolic blood pressure and mean arterial pressure over a given period of time in Group E and Group P. Mean systolic BP was less than 20% when compared to baseline in both the groups at different time intervals. In Group P the mean heart rate was significantly lower as compared to the Group E (p<0.05).Conclusions: Intravenous phenylephrine and ephedrine are both similar in performance in treating hypotension after spinal anesthesia for elective caesarean section and the hypotensive control offered is comparable.

scholarly journals Fixed-dose versus height and weight-adjusted dose of intrathecal 0.5% hyperbaric bupivacaine in elective cesarean section: A comparative study

2020 ◽  
Vol 6 (2) ◽  
pp. e217
Author(s):  
Kiran Kumar K.C. ◽  
Amir Babu Shrestha ◽  
Sangeeta Shrestha
Keyword(s):  
Cesarean Section ◽  
Onset Time ◽  
Elective Cesarean Section ◽  
Fixed Dose ◽  
Distinct Advantage ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Calculated Dose ◽  
Elective Cesarean ◽  
Adjusted Dose

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.

Influence of Lumbosacral Cerebrospinal Fluid Density, Velocity, and Volume on Extent and Duration of Plain Bupivacaine Spinal Anesthesia

2004 ◽  
Vol 100 (1) ◽  
pp. 106-114 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Jyun-ichi Hirata ◽  
Yushi Adachi ◽  
Tomiei Kazama
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Spinal Anesthesia ◽  
Onset Time ◽  
Inverse Correlation ◽  
Sensory Block ◽  
Magnetic Resonance Images ◽  
Spinal Block ◽  
Linear Regression Models ◽  
Block Level

Background The current study was designed to investigate the influence of lumbosacral cerebrospinal fluid (CSF) density, velocity, and volume on the extent and duration of plain bupivacaine spinal anesthesia. Methods Forty-one patients scheduled to undergo orthopedic surgery with spinal block were enrolled. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images. CSF velocity at the L3-L4 level was derived from phase-contrast magnetic resonance images. Spinal anesthesia was performed in the lateral decubitus position. CSF (2 ml) was sampled to measure CSF density before injection of 3 ml plain bupivacaine (0.5%). Statistical correlation coefficients (rho) between CSF characteristics and measurements of spinal anesthesia were assessed by Spearman rank correlation. In addition, stepwise multiple linear regression models were used to select important predictors of measures of spinal anesthesia. Results There was a significant correlation between CSF density and peak sensory block level (rho = 0.33, P = 0.034). Lumbosacral CSF volume inversely correlated with peak sensory block level (rho = -0.65, P &lt; 0.0001) and positively correlated with onset time of complete motor block (rho = 0.42, P = 0.008). CSF volume also inversely correlated with time required for regression of the sensory block to L1 (rho = -0.35, P = 0.026) and L2 (rho = -0.33, P = 0.039). There was a significant inverse correlation between peak diastolic CSF velocity and duration of motor blockade (rho = -0.44, P = 0.005). Multiple regression analysis revealed that weight and CSF volume significantly contributed to the peak sensory block level (R2 = 0.46). Conclusions These findings indicate that CSF density and volume influence the spread of spinal anesthesia with plain bupivacaine and that CSF volume also influences the duration of spinal anesthesia. CSF velocity might also influence the duration of plain bupivacaine spinal anesthesia.

COMPARISON OF VARIOUS PARAMETERS AFTER INDUCTION OF SPINAL ANAESTHESIA FOR CAESAREAN SECTION IN SITTING AND LATERAL POSITION

2021 ◽  
pp. 22-24
Author(s):  
Krishna Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Blood Pressure ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Elective Caesarean Section ◽  
Lateral Position ◽  
Sitting Position ◽  
Number Of Patients ◽  
Position Group

Background: Hypotension is one of the common complications in patients undergoing surgeries under spinal anesthesia. This phenomenon is comparatively more in pregnant women undergoing caesarean section under spinal anesthesia due to anatomical variations in the spinal cord and physiological changes in pregnant women. Maternal position may inuence the spread of the local anaesthetic drug. So, in this study we have aimed to compare incidence of hypotension and various other parameters like onset of sensory and motor blockade, total number of mephentermine incremental doses (5mg/dose) required in each group to correct hypotension after induction of spinal anesthesia in sitting and lateral position for caesarean sections. Methods: Seventy American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomnly divided into two groups by closed envelope technique to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). In Lumbar (L3interspace, lumbar puncture was done after taking aseptic precautions, plain bupivacaine 0.5% heavy 10 or 12 mg according to the height was injected after conrming free ow of cerebro spinal uid. After this, they were placed in the supine position immediately with right wedge providing for left lateral uterine displacement to avoid supine hypotension syndrome. Maternal blood pressure was measured every minute for 5 minutes, every two min for 10 min and 5 minutely thereafter. Hypotension was dened as a fall in systolic blood pressure >20% of the baseline value or a value <90 mmHg. Results: Statistical studies showed that number of patients who received spinal anesthesia in lateral position had signicantly more incidences of hypotension (19 incidences) compared to those who received in sitting position ( 10 incidences) with P value being (P= 0.048). And also there was faster onset (average time) of action (sensory and motor) in Group L(5 minutes for sensory and 6.2 minutes for motor) than compared to Group S (7 minutes for sensory and 7.4 minutes for motor) but not statistically signicant ( P= 0.361 for sensory and 0.639 for motor). We also observed that, total number of incremental doses (5mg/dose) of mephentermine used were more in patients who received spinal anaesthesia in lateral position (n= 10 increments) than compared to those who received in sitting position( n=5 increments) but it was not statistically signicant (P=0.145). Conclusion: Spinal anesthesia given in lateral position of the patients for caesarean section causes signicantly more incidences of hypotension than that given in sitting position. And there were no signicant differences with respect to onset of sensory and motor block and mephentermine requirement between the groups.

scholarly journals Addition of Adrenaline to Chloroprocaine Provides a Moderate Duration Time for Epidural Anaesthesia in Elective Caesarean Section

2012 ◽  
Vol 40 (3) ◽  
pp. 1099-1107 ◽  
Author(s):  
Sw Feng ◽  
Y Cao ◽  
Wg Wang ◽  
Ys Liu ◽  
Xf Shen
Keyword(s):  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Analogue Scale ◽  
Elective Caesarean Section ◽  
Onset Time ◽  
Attractive Alternative ◽  
Cold Sensation ◽  
Time Duration ◽  
Duration Time ◽  
To Receive

OBJECTIVE: Epidural anaesthesia using chloroprocaine with or without adrenaline and lidocaine with adrenaline were compared. METHODS: Sixty parturients undergoing elective caesarean section under epidural anaesthesia were randomized to receive 3% chloroprocaine (group C), 3% chloroprocaine with adrenaline (group CA) or 2% lidocaine with adrenaline (group LA). Onset time, duration time and various maternal, fetal and neonatal parameters were monitored. Pain was assessed using a visual analogue scale. RESULTS: The onset time of analgesia in group CA was similar to that in group C but was shorter than that in group LA. Duration of analgesia, loss of cold sensation and motor blockade in group CA were prolonged compared with group C, but were shorter than those in group LA. No differences in maternal, fetal or neonatal effects were seen. A higher pain score was reported in group C than in groups CA or LA at the end of surgery. CONCLUSIONS: Epidural anaesthesia using chloroprocaine with adrenaline has a quick onset and moderate duration and is an attractive alternative to lidocaine and adrenaline or chloroprocaine alone for caesarean section.

scholarly journals A comparative study of intrathecal bupivacaine and levobupivacaine for patients undergoing caesarean section

2019 ◽  
Vol 6 (6) ◽  
pp. 1792
Author(s):  
Kiranpreet Kaur ◽  
Sanjay Johar ◽  
Anil Kumar ◽  
Mamta Jain ◽  
Prashant Kumar ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Onset Time ◽  
Sensory Block ◽  
P Value ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Pregnant Females ◽  
Haemodynamic Stability ◽  
Group B

Background: The present study was conducted to compare the effects of 0.5% isobaric levobupivacaine and 0.5% hyperbaric bupivacaine in pregnant females undergoing caesarean section.Methods: Study was conducted on 100 pregnant females undergoing caesarean section. They were randomly divided into two groups B and L receiving 2 ml of 0.5% hyperbaric bupivacaine and 0.5% levobupivacaine respectively. Two groups were compared with regard to sensory block, motor block, haemodynamic stability and complications if any.Results: Time to achieve sensory blockade till T6 dermatome was prolonged in group B (162.52±80.55 sec) as compared to group L (139.40±49.79 seconds) (p value= 0.087). Prolonged duration of motor blockade was observed in group B (160.76±6.56 minutes) as compared to group L (131.48±14.42 minutes) (p<0.001). Less haemodynamic stability was seen in patients of group B with more incidence of hypotension and bradycardia.as compared to group L.Conclusions: Levobupivacaine is nearly equally effective to bupivacaine to produce sensory and motor blockade with comparable onset time and better haemodynamic stability with lesser side effects.

scholarly journals PERIOPERATIVE EFFECTS OF INTRATHECAL CLONIDINE AND FENTANYL WITH HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR VAGINAL HYSTERECTOMY

2016 ◽  
Vol 9 (5) ◽  
pp. 245
Author(s):  
Suman Chattopadhyay ◽  
Mallika Datta ◽  
Biswanath Biswas
Keyword(s):  
Placebo Group ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Mechanisms Of Action ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Prolonged Duration ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

ABSTRACTObjectives: Intrathecal fentanyl and clonidine are effective analgesics with different mechanisms of action. This study compares 25 µg of both thesedrugs given intrathecally regarding onset, quality, and duration of hyperbaric bupivacaine-induced spinal block and side effects.Methods: A total of 90 patients of ASA I and II were randomly allocated into three equal groups. Group A received 0.5 ml of 0.9% normal saline(placebo), Group B and Group C received 25 µg fentanyl and clonidine intrathecally added to 2.5 ml of 0.5% hyperbaric bupivacaine, respectively. Theonset and regression time of sensory and motor blocks were recorded along with hemodynamic change, side effects, pain intensity (in terms of visualanalog score (VAS), and time to first rescue analgesic.Results: Intrathecal clonidine (25 μg) significantly prolongs sensory and motor blocks, with prolonged duration of analgesia in comparison withintrathecal fentanyl (25 µg) (325±15 minutes vs. 240±7.6 minutes). VAS score was similar, but sedation was more in clonidine group.Conclusion: We conclude that low-dose intrathecal clonidine is an effective adjuvant to bupivacaine for spinal anesthesia and provides betterpostoperative analgesia in comparison with intrathecal fentanyl.Keywords: Clonidine, Fentanyl, Bupivacaine, Regional, Spinal, Postoperative pain.

scholarly journals Comparison of hemodynamic effect between the spinal anesthesia and saddle block during transurethral resection of the prostate

2021 ◽  
Vol 23 (09) ◽  
pp. 817-828
Author(s):  
Dr. Farooq Taher Abdulqader ◽  
◽  
Dr. Ali Abd-Alhameed Mohammed ◽  
Keyword(s):  
Spinal Anesthesia ◽  
Transurethral Resection ◽  
Major Complication ◽  
Hemodynamic Effect ◽  
Spinal Block ◽  
Transurethral Resection Of Prostate ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The best technique for transurethral resection of prostate (TURP) is regional anesthesia. The hypotension is the major complication following spinal anesthesia. The hemodynamic changes is less with saddle block than spinal block. Aim and Objective: To compare hemodynamic effect between the spinal block and saddle block in TURP. Patients and methods: 50 patients between 50-70 years old ASA I – II prepared for TURP, divided randomly in two groups 25 pt. in each group. Group A received spinal 10 mg of hyperbaric bupivacaine (2 ml of 0.5%), were group B received saddle block 10 mg of hyperbaric bupivacaine (2 ml of 0.5%). The blood pressure, oxygen saturation, heart rate measured and recorded subsequently. The hypotension treated by 100 mcg bolus of phenylephrine. Results: In our study there was statically significant difference (p < 0.05) between group A which received spinal anesthesia and group B which received saddle block in hemodynamic effect. In which the incidence of hypotension and vasopressor requirement more in group A. Conclusion: Under saddle block the TURP can safely performed with low risk of hypotension and less requirement of vasopressor.

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