title: Is there an advantage in using low-dose intrathecal bupivacaine for cesarean section?
abstract: 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.
authors.affiliation: Department of Anesthesiology and Reanimation, Mustafa Kemal University, Antakya/Hatay 31100, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Turhanoglu
authors.forename: Sedat
authors.initials: S
authors.lastname: Kaya
authors.forename: Hulya
authors.initials: H
authors.lastname: Erdogan
mesh_terms: 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
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D005283:Fentanyl; D002045:Bupivacaine
references.citation: Anesth Analg. 2001 Apr;92(4):997-1005
references.pmid: 11273939
references.citation: Anaesthesia. 2003 May;58(5):428-31
references.pmid: 12693997
references.citation: Reg Anesth Pain Med. 2000 May-Jun;25(3):235-9
references.pmid: 10834776
references.citation: Acta Anaesthesiol Scand. 2003 Jan;47(1):13-9
references.pmid: 12492791
references.citation: Br J Anaesth. 2001 Nov;87(5):772-4
references.pmid: 11878530
references.citation: Anaesthesia. 2005 Jan;60(1):28-34
references.pmid: 15601269
references.citation: Acta Anaesthesiol Scand. 2003 Sep;47(8):986-92
references.pmid: 12904191
references.citation: Anesthesiology. 2004 Mar;100(3):676-82
references.pmid: 15108985
references.citation: Int J Obstet Anesth. 2006 Oct;15(4):273-8
references.pmid: 16774830
references.citation: Acta Anaesthesiol Sin. 1998 Dec;36(4):207-14
references.pmid: 10399516
references.citation: Drug Saf. 2001;24(6):413-42
references.pmid: 11368250
references.citation: Anesthesiology. 2001 Apr;94(4):593-8; discussion 5A
references.pmid: 11379678
references.citation: Anesth Analg. 2000 May;90(5):1162-6
references.pmid: 10781472
references.citation: Anesth Analg. 2006 Jul;103(1):187-90, table of contents
references.pmid: 16790651
references.citation: Anesthesiology. 2002 Dec;97(6):1582-90
references.pmid: 12459688