Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?
OBJECTIVE
Spinal anesthesia for cesarean section is associated with a high incidence of maternal hypotension. The aim of this study was to assess the efficacy of low-dose bupivacaine with fentanyl to reduce the incidence of hypotension in spinal anesthesia for cesarean section.


METHODS
Forty pregnant women undergoing elective cesarean section were randomly allocated to two groups; those receiving 10 mg bupivacaine to group B (n = 20) and those receiving 4 mg bupivacaine plus 25 microg fentanyl to group BF (n = 20); the agents were given intrathecally with patients in the sitting position, with a combined spinal-epidural technique.


RESULTS
Sensory block was adequate for surgery in all patients. Hypotension occurred in all patients in group B (100%) and in 15 patients in group BF (75%). The incidence of hypotension, number of ephedrine treatments, and need for ephedrine were significantly greater in group B than group BF. Three patients in group BF required i.v. fentanyl supplementation after delivery. In 1 of these patients, i.v. fentanyl was not adequate, and epidural supplementation of 1% lidocaine was required.


CONCLUSIONS
The development of hypotension after spinal block in subjects undergoing cesarean section was not prevented despite low-dose (4 mg) bupivacaine plus 25 microg fentanyl, but the severity of maternal hypotension, and the number of ephedrine treatments and the total dose of ephedrine were decreased.
Turhanoglu
Selim
S
Department of Anesthesiology and Reanimation, Mustafa Kemal University, Antakya/Hatay 31100, Turkey.
Kaya
Sedat
S
Erdogan
Hulya
H
D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology; D007231:Infant, Newborn; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D005283:Fentanyl; D002045:Bupivacaine
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