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.
Teoh
W H L
WH
Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore. teohwendy@yahoo.com
Ithnin
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Sia
A T H
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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