Comparison of an equal-dose spinal anesthetic for cesarean section and for post partum tubal ligation.
BACKGROUND
We postulated that a spinal dose of hyperbaric bupivacaine 12 mg and morphine 100 microg administered for cesarean section would yield an equivalent sensory block height and provide sufficient analgesia if administered within 48 h of delivery for postpartum tubal ligation.


METHODS
20 women undergoing postpartum tubal ligation (PPTL) within 48 h of vaginal delivery and 20 undergoing cesarean section (CS) were recruited. Spinal anesthesia was induced with intrathecal hyperbaric bupivacaine 12 mg and morphine 100 microg at L3/4 with patients in the right lateral position.


RESULTS
Baseline demographics of groups were comparable, but tubal ligation patients had greater parity, with a mean+/-SD 14.5+/-7.5 h from delivery to spinal anesthesia, and shorter duration of surgery, 21.4+/-7.6 vs. 35.3+/-11.3 min. Maximal sensory block was higher in group CS than PPTL, T2 (T1-T4) vs. T3 (T2-T5), P=0.001; time to reach maximal level did not differ significantly, (6.9+/-3.9 vs. 8.7+/-2.8 min, P=0.091). There was no difference in time for spinal block to recede two segments or to T10, and for motor block recovery to Bromage 2, all P>0.05. More CS patients were hypotensive (80% vs. 45%, P=0.048) and had intraoperative nausea (25% vs. 0%, P=0.047), but mean phenylephrine and ephedrine usage did not differ significantly.


CONCLUSIONS
An equivalent dose of hyperbaric bupivacaine 12 mg and morphine 100 microg for both CS and PPTL resulted in a higher sensory block, more hypotension and nausea in CS patients. The studied regimen might be appropriate for PPTL, but appears excessive for CS.
Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore. teohwendy@yahoo.com
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D000328:Adult; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002585:Cesarean Section; D005260:Female; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods / Q000706:statistics & numerical data; D009043:Motor Activity / Q000187:drug effects; D011183:Postoperative Complications / Q000209:etiology*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012677:Sensation / Q000187:drug effects*; D018709:Statistics, Nonparametric; D013246:Sterilization, Tubal; D013997:Time Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine