[Low-dose 0.25% spinal levobupivacaine with epidural extension for cesarean section: comparison with 0.5% hyperbaric bupivacaine].
BACKGROUND
When low doses of local anesthetic are used in combined spinal-epidural anesthesia for cesarean section, an epidural catheter can be used to enhance a possibly incomplete block or insufficient dose.


OBJECTIVE
To compare the efficacy of spinal 0.5% hyperbaric bupivacaine with fentanyl (20 microg) at a conventional high dose of 0.07 mg cm(-1) (group 1) vs 0.25% levobupivacaine at a low dose of 7.6 mg with fentanyl (20 microg) and epidural volume extension with 6 mL of saline through an epidural catheter (group 2).


METHODS
A randomized clinical trial enrolling patients scheduled for elective cesarean section.


RESULTS
Sixty-two patients were studied (31 in each group). Characteristics in the groups were comparable at baseline and the maximum level of sensory block achieved was sufficient for all but 1 patient in group 2 who required general anesthesia. The bupivacaine dose in group 1 ranged from 10.5 to 12 mg. The motor block and duration was less intense in group 2 (P<0.0001) and patients in that group could be transferred out of the postanesthetic care unit earlier.


CONCLUSIONS
The use of low doses of levobupivacaine with an opiate in combination with volume extension through an epidural catheter in the context of combined spinal-epidural anesthesia is a safe, effective technique that may allow the doses and motor block to be reduced when hyperbaric levobupivacaine is administered, without adverse events for patients.
Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Maternidad, Madrid.
J M
JM
Vicente
E V
EV
Guasch
J M
JM
Bermejo
F
F
Gilsanz
D000328:Adult; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000295:instrumentation / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000295:instrumentation / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D001034:Apgar Score; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D002404:Catheterization; D002585:Cesarean Section; D004305:Dose-Response Relationship, Drug; D004824:Epidural Space; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006982:Hypertonic Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D007022:Hypotension / Q000139:chemically induced; D007231:Infant, Newborn; D000077554:Levobupivacaine; D009068:Movement / Q000187:drug effects; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000517:prevention & control; D011247:Pregnancy; D011446:Prospective Studies; D012677:Sensation / Q000187:drug effects
D000779:Anesthetics, Local; D006982:Hypertonic Solutions; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine