Mepivacaine for spinal anesthesia in parturients undergoing elective cesarean delivery: maternal and neonatal plasma concentrations and neonatal outcome.
OBJECTIVE
Worldwide, long-acting bupivacaine is most commonly used for spinal anesthesia in parturients undergoing elective Cesarean delivery. However, advances in surgical technique and shorter duration of surgery make short-acting local anesthetic like mepivacaine appropriate, particularly if combined with opioids to enhance postoperative maternal pain relief.


METHODS
We assessed the effect of 4% hyperbaric mepivacaine (60 mg) plus 10 microg fentanyl for spinal anesthesia in 11 parturients undergoing elective Cesarean delivery. Sensory, motor and analgesic block characteristics, neonatal outcome (Apgar scores, umbilical cord blood analysis, neurologic and adaptive capacity score) as well as fetal and maternal mepivacaine plasma concentrations at delivery were determined (HPLC/UV).


RESULTS
Motor block (Induction-Bromage 0) duration lasted 113 +/- 20 min. Effective analgesia (VAS < or = 40) was 128 +/- 35 min. Maternal and fetal mepivacaine free plasma concentration were 0.18 +/- 0.05 microg/ml and 0.10 +/- 0.03 microg/ml, respectively. The fetal to maternal (UV/MV)-ratio for mepivacaine free plasma concentration was 0.56. Apgar scores, NACScores and the umbilical blood analysis showed no evidence of neonatal depression.


CONCLUSIONS
Particularly with short duration of surgery (21 +/- 5 min) intrathecal mepivacaine combined with fentanyl offers a favorable clinical alternative in parturients undergoing elective Cesarean delivery.
Bremerich
D H
DH
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johannes Wolfgang Goethe-Universität, Frankfurt am Main. Bremerich@em.uni-frankfurt.de
Schlösser
R L
RL
L'Allemand
N
N
Brandes
R P
RP
Ahr
A
A
Piorko
D
D
Kaufmann
M
M
Kessler
P
P
D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics*; D001034:Apgar Score; D002585:Cesarean Section; D002851:Chromatography, High Pressure Liquid; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008619:Mepivacaine / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics*; D011247:Pregnancy; D013997:Time Factors; D014471:Umbilical Veins
D000779:Anesthetics, Local; D008619:Mepivacaine; D005283:Fentanyl