Single bolus compared with a fractionated dose injection technique of bupivacaine for extradural Caesarean section: effect on uteroplacental and fetal haemodynamic state |
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Authors: | Karinen J; Makarainen L; Alahuhta S; Jouppila R; Jouppila P |
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Institution: | Department of Anaesthesia, Oulu University Hospital, Kajaanintie 52 A, FIN-90220 Oulu, Finland; Department of Obstetrics and Gynaecology, Oulu University Hospital, Kajaanintie 52 A, FIN-90220 Oulu, Finland |
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Abstract: | We studied 26 healthy parturients undergoing elective Caesarean section,
allocated randomly to receive extradural block with 0.5% plain bupivacaine
in a double-blind manner in either a single bolus or fractionated doses.
After a 3-ml test dose, an additional 20 ml of bupivacaine were given over
a 5-min period in the single bolus group (n = 13) and over a 25-min period
in the fractionated dose group (n = 13). We studied the effects of
bupivacaine on blood flow velocities in the maternal placental and
non-placental uterine and fetal umbilical arteries before and four times
during establishment of extradural block using a pulsed colour Doppler
technique. Median sensory block reached T3 in the single-dose group
compared with T4 in the fractionated-dose group. Two subjects in each group
required i.v. ephedrine to correct transient hypotension (systolic arterial
pressure < 90 mm Hg). Blood flow velocity waveform indices of the
uterine and umbilical arteries did not differ significantly within or
between groups during the study. There was no significant difference in
neonatal outcome, as assessed by Apgar scores and umbilical artery pH
values. In conclusion, we observed no deterioration in uteroplacental
circulation after administration of a single bolus dose of bupivacaine.
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