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COMPARISON OF HEIGHT – WEIGHT ADJUSTED DOSE OF HEAVY BUPIVACAINE TO A STANDARD DOSE FOR SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION
Abstract
Hypotension after spinal anaesthesia for caesarean section remains a common and potentially serious complication, despite the use of left uterine displacement, leg elevation and wrapping, fluid loading with crystalloids or colloids, and prophylactic and therapeutic use of pharmacological drugs. Hypotension is defined as a decrease in baseline systolic blood pressure of more than 30% or systolic blood pressure of less than 100 mmHg. The clinical importance of this side effect was shown in a study by Bernd 2002, who proved that hypotensive episodes detected by an automated record-keeping system clearly correlate with mortality. Other complications such as shivering, nausea, and peritoneal discomfort also occur.
In this prospective, randomised, double-blind study, the effects of two dosage regimens were compared. Pregnant patients at term were randomly assigned to two groups to be given 0.5% hyperbaric bupivacaine 2.4 ml or hyperbaric bupivacaine 0.5% adjusted according to the patient’s height and
eight. Adequate anaesthesia was provided in all patients in the fixed dose group while six patients in the adjusted group required supplemental analgesia. The time to loss of cotton wool sensation to maximum block height was faster with the fixed dose regimen (p = 0.001) Hypotension occurred in 62.9% vs. 28.6% of patients in the fixed dose and adjusted dose groups respectively (p = 0.001).
In the fixed dose group, more patients required ephedrine to treat hypotension (62.9% vs. 28.6%, p = 0.001) and a larger median dose were administered (6 mg vs. 3 mg, p = 0.001). The decrease in mean (SD) arterial pressure was less in the adjusted dose group (18-71 mmHg vs. 23-71 mmHg, p = 0.001) compared to the fixed dose group.
This study shows that satisfactory anaesthesia for an elective caesarean section can be provided with adjusted doses of 0.5% of hyperbaric bupivacaine, and complications minimized.
