Optimal intrathecal hyperbaric bupivacaine dose with opioids for cesarean delivery: a prospective double-blinded randomized trial |
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| Institution: | 1. Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan;2. Department of Anesthesiology, Tohoku Kosai Hospital, 2-3-11, Kokubuncho, Aoba-ku, Sendai, Miyagi, Japan;3. Department of Anesthesiology, Kesennuma City Hospital, 184 Tanaka, Kesennuma, Miyagi, Japan;1. Department of Anaesthesia, Pharmacology & Intensive Care, Geneva University Hospital, Switzerland;2. Department of Anesthesia, Centre Medical de Kourou, Croix-Rouge Française, French Guiana;3. Division of Clinical Epidemiology, Geneva University Hospital-University of Geneva, Switzerland;1. Service d’anesthésie et de réanimation, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille, Aix Marseille Université, Marseille, France;2. Service de réanimation DRIS, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille, Aix Marseille Université, Marseille, France;3. Service de gynécologie et d’obstétrique, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille, Aix Marseille Université, Marseille, France;4. Unité d’Aide Méthodologique à la Recherche Clinique et Épidémiologique, Aix Marseille Université, Marseille, France;5. Centre d’Investigation Clinique 1409, Aix Marseille Université, Assistance Publique–Hôpitaux de Marseille, Marseille, France;2. Department of Ophthalmology, Nara Medical University, Nara, Japan;3. Medical Technology Center, Nara Medical University Hospital, Nara, Japan;4. Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan;1. Department of Anaesthesiology, Spital Münsingen, Insel Gruppe AG, Münsingen, Switzerland;2. Department of Anaesthesiology, University Hospital Würzburg, Würzburg, Germany;3. Geographic Information Solutions and Database Management, Condesys Consulting GmbH, Rubigen, Switzerland;4. Statistical Consultancy and Data Analysis, Statistik und Beratung, Kürnach, Germany;5. Institute for Anaesthesia and Intensive Care Medicine, Spital Thurgau Frauenfeld, Frauenfeld, Switzerland;6. Department of Anaesthesiology, University Hospital Basel, University of Basel, Switzerland |
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| Abstract: | BackgroundSingle-shot spinal anesthesia is commonly used for cesarean delivery. Achieving adequate anesthesia throughout surgery needs to be balanced with associated complications. We investigated the optimal dose of intrathecal hyperbaric bupivacaine, co-administered with opioids, for anesthesia for cesarean delivery.MethodsThis prospective, randomized, double-blinded, dose-ranging trial included parturients scheduled to undergo cesarean delivery under spinal anesthesia. An epidural catheter was first inserted at the T11–12 vertebral interspace, followed by spinal anesthesia at the L2–3 or L3–4 vertebral interspace. Subjects were randomly assigned to one of seven doses of intrathecal hyperbaric bupivacaine 0.5% (6, 7, 8, 9, 10, 11 or 12 mg), with added 15 μg fentanyl and 75 μg morphine. Successful induction of anesthesia (successind) was defined as achievement of bilateral sensory loss to cold at the T6 dermatome or higher, within 10 minutes. Successful maintenance of anesthesia (successmain) was defined by no epidural supplementation within 60 minutes of intrathecal injection. The effective doses for 50% (ED50) and 95% (ED95) of patients were estimated using logistic regression analysis.ResultsThe ED50 and ED95 for successmain were 6.0 mg (95% CI: 4.5 to 7.5 mg) and 12.6 mg (95% CI: 7.9 to 17.2 mg), respectively. The incidence of respiratory discomfort and maternal satisfaction scores did not differ significantly between dose groups. Phenylephrine dose and nausea/vomiting incidence increased with increasing doses of bupivacaine.ConclusionUnder study conditions, our results suggest that 12.6 mg of intrathecal bupivacaine, administered with fentanyl and morphine, is required to achieve adequate intraoperative analgesia without the need for epidural supplemention. |
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| Keywords: | Cesarean delivery Hyperbaric bupivacaine Spinal anesthesia |
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