title: A randomized comparison of onset of anesthesia between spinal bupivacaine 5 mg with immediate epidural 2% lidocaine 5 mL and bupivacaine 10 mg for cesarean delivery.
abstract: BACKGROUND
  Previous studies using low-dose spinal anesthesia for cesarean delivery have focused on hypotension and efficacy. This study evaluated whether, using a combined spinal-epidural technique, there was a difference in onset of anesthesia for cesarean delivery between low-dose spinal with an immediate epidural local anesthetic bolus, and conventional-dose spinal anesthesia.
  
  
  METHODS
  Forty healthy term nulliparous women undergoing elective cesarean delivery with a combined spinal-epidural technique were enrolled into this prospective, randomized, double-blind study. Patients were randomly allocated to the low-dose (Group L) or conventional-dose group (Group C). Patients in Group L received intrathecal isobaric bupivacaine 5 mg with sufentanil 2.5 μg followed by epidural 2% lidocaine 5 mL; patients in Group C received intrathecal isobaric bupivacaine 10 mg with sufentanil 2.5 μg followed by epidural saline 5 mL. The onset of anesthesia (defined as the time from spinal injection to a block to T6), incidence of hypotension, maximal sensory block, epidural supplementation and side effects were recorded.
  
  
  RESULTS
  All blocks reached T6 within 11 min except for one patient in Group L. There were no differences in onset of anesthesia (9.9 ± 3.2 min in Group L vs. 8.5 ± 1.2 min in Group C, P = 0.08), maximal block level and the number of patients who required epidural supplementation in both groups. Hypotension occurred in 8 patients (40%) in Group L and 15 patients (75%) in Group C (P = 0.02).
  
  
  CONCLUSIONS
  Intrathecal bupivacaine 5 mg with immediate 2% epidural lidocaine 5 mL provided comparable onset and efficacy of anesthesia as bupivacaine 10 mg with immediate epidural normal saline 5 mL for cesarean delivery.
authors.affiliation: Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China. Electronic address: jxlzw@sina.com.
authors.forename: L Z
authors.initials: LZ
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China.
authors.forename: Y F
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China.
authors.forename: X X
authors.initials: XX
authors.lastname: Hu
authors.affiliation: Department of Anesthesiology, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, Zhejiang Province, China.
authors.forename: X Y
authors.initials: XY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000493:pharmacokinetics*; D002045:Bupivacaine / Q000493:pharmacokinetics*; D002585:Cesarean Section / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000493:pharmacokinetics*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine
keywords: Anesthesia; Cesarean section; Obstetrical; Spinal