Mp. Vercauteren et al., SMALL-DOSE HYPERBARIC VERSUS PLAIN BUPIVACAINE DURING SPINAL-ANESTHESIA FOR CESAREAN-SECTION, Anesthesia and analgesia, 86(5), 1998, pp. 989-993
In a double-blind, randomized trial, 98 parturients undergoing cesarea
n section received either hyperbaric or plain bupivacaine 6.6 mg combi
ned with sufentanil 3.3 mu g as part of a combined spinal-epidural pro
cedure. To prevent hypotension, 1000 mt of lactated Ringer's solution,
500 mt of hydroxyethyl starch 6%, and ephedrine 5 mg were administere
d IV. The height of the block was equal in both groups, but more patie
nts in the plain group had blocks that were either too high or too low
(P < 0.01). The number of patients requiring epidural supplementation
was equal in both groups. Strict criteria were used to treat hypotens
ion. The overall incidence of systolic blood pressure (<90 mm Hg) was
13%, whereas it was more pronounced in the plain group (21% vs 6% in t
he hyperbaric group, P < 0.05), which required more ephedrine (P < 0.0
5) and in which a greater incidence of nausea was noticed (P < 0.05).
We conclude that the use of a small dose of intrathecal bupivacaine co
mbined with sufentanil plus our described preloading regimen resulted
in a lower incidence of hypotension. Further, we conclude that the use
of hyper baric bupivacaine in this manner provides a more reliable bl
ock and a lower incidence of hypotension than plain bupivacaine. Impli
cations: A small dose of hy perbaric bupivacaine 0.5% combined with su
fentanil used intrathecally during cesarean section offered a more rel
iable cephalad spread of the spinal block than the glucose-free combin
ation, which was reflected in a lower incidence of hypotension and nau
sea.