scholarly journals Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

2020 ◽  
Vol 9 (11) ◽  
pp. 3600
Author(s):  
Katarzyna Białowolska ◽  
Bartosz Horosz ◽  
Agnieszka Sękowska ◽  
Małgorzata Malec-Milewska
Keyword(s):  
Spinal Anaesthesia ◽  
Dose Regimen ◽  
Dose Group ◽  
Randomised Trial ◽  
Sensory Block ◽  
Fixed Dose ◽  
Spinal Block ◽  
Success Rates ◽  
Hyperbaric Bupivacaine ◽  
Adjusted Dose

The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9–13 mg) with fentanyl. Sensory block ≥ T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p > 0.05). Eight spinals in each group failed to produce a block ≥ T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block ≥ T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

Adjusting enoxaparin dosage according to anti-FXa levels and pregnancy outcome in thrombophilic women

2016 ◽  
Vol 116 (10) ◽  
pp. 687-695 ◽  
Author(s):  
Zohar Nachum ◽  
Israel Gavish ◽  
Shabtai Romano ◽  
Meirav Braverman ◽  
Gali Garmi ◽  
...  
Keyword(s):  
Dose Group ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Factor Xa ◽  
Preterm Births ◽  
Fixed Dose ◽  
Composite Outcome ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Adjusted Dose

SummaryWomen with thrombophilias and previous placenta-mediated pregnancy complications (PMPC) have an increased risk of both recurrent PMPC and venous thromboembolism (VTE) during subsequent pregnancies. We aimed to examine whether enoxaparin dose adjusted according to anti-factor Xa levels compared to a fixed dose would reduce the risk of PMPC in subsequent pregnancies. In a randomised trial, conducted at a single teaching hospital, pregnant women with thrombophilia and previous PMPC were enrolled in a 1:1 ratio to either a fixed dose of 40 mg daily enoxaparin or adjusted dose according to anti-factor Xa plasma levels. The primary outcome was a composite that included any of the following: pregnancy loss after enrollment, pre-eclampsia, birthweight <10th percentile, placental abruption, or VTE. Overall, 144 women were needed to detect a decrease of 20 % in the incidence of the composite outcome among the adjusted dose group. Between 2009 and 2015, 144 women consented; four in the fixed-dose group were excluded. Overall, 66 and 74 in the fixed- and adjusted-dose groups, respectively, were included. Demographic and obstetric characteristics were comparable. Composite outcome occurred in 12 (18.2 %) and 20 (27.0 %) women in the fixed- and adjusted-dose groups, respectively (p=0.24). Gestational age at delivery, preterm births, and birthweights were similar between the two groups. In conclusion, dose of enoxaparin adjusted according to anti-factor Xa levels compared to fixed dose, does not reduce the risk of PMPC recurrence in thrombophilic women.ClinicalTrial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01068795.

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.

scholarly journals 050419-OA- Spinal-Beena

2019 ◽  
pp. 162-167
Author(s):  
Tariq H Khan
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Primary Objective ◽  
Spinal Block ◽  
Hemodynamic Parameters ◽  
Hyperbaric Bupivacaine ◽  
Voiding Function ◽  
Group A ◽  
Group B

Background: Spinal anaesthesia is a reliable and safe technique for infra-umbilical surgeries. Preservative-free 2-chloroprocaine has re-emerged for use in spinal anaesthesia. We compared onset and duration of sensory block with intrathecal use of 1% 2-Chloroprocaine (30 mg) or 0.5% Hyperbaric Bupivacaine (15 mg) as primary objective. Secondary objectives being onset and duration of motor block, duration of analgesia, time to return of voiding function, hemodynamic parameters and side effects. Materials and Methods: 90 patients of age group 18-60 years, either sex, belonging to ASA physical status I/II undergoing infra-umbilical surgeries were randomly divided into two groups, 1% 2-chloroprocaine Group A (n=45) and 0.5% hyperbaric bupivacaine Group B (n=45). Each group received intrathecally either 30 mg of 2-Chloroprocaine or 15 mg of hyperbaric bupivacaine 15 mg. For statistical analysis unpaired-t-test and chi-square test were used.  Results: Earlier onset and shorter duration of sensory block were observed in Group A as compared to Group B respectively (p < 0.001). Similarly, onset was earlier and duration of motor block, duration of analgesia and time to return of voiding function were shorter in Group A as compared to Group B respectively (p < 0.001). Hemodynamic parameters (HR, MAP) were comparable in both groups. Conclusion: Intrathecal 1% 2-Chloroprocaine 30 mg provides spinal anaesthesia of adequate duration for infra-umbilical surgeries with the advantage of earlier onset and faster regression of spinal block resulting in earlier voiding with stable hemodynamics as compared to 0.5% hyperbaric bupivacaine 15 mg. Keywords: Infra-umbilical surgeries, 2- chloroprocaine, Bupivacaine, Spinal Anaesthesia, Sensory Block, Motor Block.

scholarly journals Spinal Anaesthesia: Is it Safe in Younger Children?

1970 ◽  
Vol 6 (1) ◽  
pp. 25-28
Author(s):  
M Ahmed ◽  
NP Ali ◽  
SMH Kabir ◽  
M Nessa
Keyword(s):  
Spinal Anaesthesia ◽  
Neurological Complication ◽  
Armed Forces ◽  
Sensory Block ◽  
Supplemental Oxygen ◽  
Active Management ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Sinus Arrhythmia ◽  
Medical College

The characteristics of spinal block including ease of performance, efficacy, adverse effects and complicationswere evaluated in 78 children aged between 2-6 years undergoing different types of surgery in lower part ofbody. Spinal block was performed in sedated children with 0.5% hyperbaric bupivacaine at a dose of 0.25mg/kg. Haemodynamically patients were stable in most of the cases. In general pulse rate was increased by9.8% while systolic and diastolic blood pressures were reduced by 6.8% and 8.7% respectively from baselinelevel after 15 min of block, which didn't warrant any active management. One patient was treated withinjection atropine for bradycardia (<60 beats/min). Two patients had clinically significant hypotension(reduction of systolic blood pressure >20% from baseline level) and were easily managed with injectionephedrine hydrochloride. Two patients had insignificant sinus arrhythmia during operation and threerequired temporary supplemental oxygen support by mask to maintain oxygen salutation >94%. Motor blockwas complete in all but two cases. Sensory block showed wide variation of height, from first thoracic toseventh thoracic (4th thoracic). Time of two segment regression of block was 74 min (range 30-190 min). Meantime of giving rescue analgesic after spinal block was 118 min (range 59-240 min). One patient vomited andfive had shivering in the recovery room. There was no incidence of systemic toxicity of bupivacaine (urinaryretention, post dural puncture headache or any other neurological complication). Spinal block was observed tobe easier, safer and very effective anaesthetic technique even in younger children.Key words: Spinal anaesthesia; children; complication.DOI: 10.3329/jafmc.v6i1.5988Journal of Armed Forces Medical College, Bangladesh Vol.6(1) 2010 p.25-28

scholarly journals Sciatic obturator femoral technique versus spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. A randomised trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hoda Shokri ◽  
Amr A. Kasem
Keyword(s):  
Adverse Events ◽  
Spinal Anaesthesia ◽  
External Fixator ◽  
Randomised Trial ◽  
Study Groups ◽  
Tibial Fractures ◽  
Hyperbaric Bupivacaine ◽  
Ilizarov External Fixator ◽  
Open Tibial Fractures ◽  
Significant Difference

Abstract Background Peripheral nerve block is preferable for lower extremity surgery because it sufficiently blocks pain pathways at different levels providing excellent anaesthesia at the site of surgery. We designed this study to compare the efficacy and safety of SOFT block (sciatic-obturator-femoral technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. Methods One hundred and seven patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7. 5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, visual analogue scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic drug and time to first effect of the techniques. Results The duration of SOFT block and time to first analgesic dose in SOFT group was significantly longer (p < 0.001). There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and paraesthesia. Pain scores were significantly lower in SOFT group at 3,6,12 h postoperative (p < 0.001). The time to the first effect was significantly longer in SOFT group (p < 0.001). Conclusion SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing fixation of tibial fractures using Ilizarov external fixator. Trial registration This trial was retrospectively registered at ClinicalTrials.gov. registry number: NCT03450798 on February 20, 2018.

scholarly journals Comparison of Intrathecal Fentanyl and Butorphanol as an Adjuvant to Intrathecal Bupivacaine 0.5% in Infraumbilical Surgeries- A Randomised Double Blind Study

2020 ◽  
Author(s):  
Sandip Roy Basunia ◽  
Prosenjit Mukherjee ◽  
Md Bakir Hossain Munshi
Keyword(s):  
Spinal Anaesthesia ◽  
Motor Block ◽  
Controlled Trial ◽  
Sensory Block ◽  
P Value ◽  
Double Blind Study ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Group A ◽  
Group B

Introduction: Neuraxial opioids are widely used as adjuvants to local anaesthetic as they improve quality and duration of block. Neuraxial opioids like Butorphanol and Fentanyl allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Aim: To compare the safety and efficacy of Butorphanol and Fentanyl combined with bupivacaine for spinal anaesthesia in infraumbilical surgeries. Materials and Methods: The present study was a randomised controlled trial in which 110, ASA I and II patients of either sex who underwent elective infraumbilical surgeries under spinal anaesthesia were selected. Patients were allocated randomly into two groups A (n=55) and B (n=55). Group A (F) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with fentanyl 25 microgram (0.5 mL) to make it total 3.5 mL. Group B (B) received intrathecal 0.5% hyperbaric bupivacaine 12.5 mg (3 mL) with butorphanol 250 microgram (0.25 mL) and Normal Saline (NS) 0.25 mL to make it total 3.5 mL. Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed at preset intervals. Chi-square test or Fischer’s-exact test were used and a p-value ≤0.05 was considered as statistically significant. Results: Mean of two segment sensory regression time of Group A was 41.94±1.73 minutes and Group B was 50.56±4.43 minutes (p<0.0001). Time to onset of motor block in Group A was 5.28±.32 minutes and Group B was 5.27±.32 minutes (p=0.96). Mean duration of motor block in Group A was 81.23±4.87 minutes and Group B was 109.83±2.61 minutes (p<0.0001). Time to rescue analgesic was 289.27±7.37 minutes in Group A and 378.41±10.25 minutes in Group B (p<0.0001). HR, SBP and DBP were comparable among the groups. Conclusion: Intrathecal bupivacaine-butorphanol mixture was clinically better as it provided longer duration of analgesia with lesser incidences of pruritus and nausea/vomiting compared to intrathecal fentanyl-bupivacaine mixture.

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.

Subanalgesic doses of ketamine and morphine but not morphine alone, prolong the sensory block time of hyperbaric bupivacaine in unilateral spinal anaesthesia

2004 ◽  
Vol 16 (4) ◽  
pp. 435-439
Author(s):  
Emin Alp Yentür ◽  
Demet Tok ◽  
Gönül Tezcan Keleş ◽  
Verda Toprak ◽  
Füsun Aslan
Keyword(s):  
Spinal Anaesthesia ◽  
Sensory Block ◽  
Hyperbaric Bupivacaine ◽  
Block Time

scholarly journals Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ozden Gorgoz Kaban ◽  
Dilek Yazicioglu ◽  
Taylan Akkaya ◽  
M. Murat Sayin ◽  
Duray Seker ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Controlled Trial ◽  
Sensory Block ◽  
Local Anaesthetics ◽  
Day Case ◽  
Hyperbaric Bupivacaine ◽  
Versus Group ◽  
Group B ◽  
Randomised Controlled ◽  
Fentanyl Group

Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia.Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume.Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P4.6±1.3 min versus Group B5.9±01.9 min,P=0.017, and Group P13.2±7.5 min versus Group B15.3±6.6 min,P=0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7±21.9 min versus59.7±20.9 min,P=0.024, and133.8±41.4 min versus200.4±64.8 min,P<0.001). The mean time to home readiness was shorter for Group P than for Group B (155±100.2 min versus207.2±62.7 min(P<0.001)).Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery.

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