title: Spinal anaesthesia with low-dose bupivacaine in marginally hyperbaric solutions for caesarean section: A randomised controlled trial.
abstract: BACKGROUND
  Conventional hyperbaric spinal anaesthesia solution (SAS) with 8% glucose and low-dose bupivacaine may reduce the incidence of hypotension in caesarean section compared to standard doses, and marginally hyperbaric SAS (≤0.8% glucose) can induce a lower block level and a lower incidence of hypotension in nonobstetric patients than conventional 8% glucose SAS.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the clinical efficacy of marginally hyperbaric low-dose bupivacaine solutions used for spinal anaesthesia during caesarean section.
  
  
  METHODS
  A randomised, controlled clinical trial.
  
  
  METHODS
  Single medical centre.
  
  
  METHODS
  One hundred twenty women scheduled for elective caesarean section were randomised into four groups.
  
  
  METHODS
  Caesarean section after combined spinal-epidural anaesthesia using hyperbaric preparations of low-dose SAS (7.2 mg bupivacaine and 2 μg 1.6 ml sufentanil in one of the following: 8%, 0.8%, 0.5% or 0.33% glucose solution.
  
  
  METHODS
  The dermatomal sensory block and degree of motor block of the lower extremities and adverse effects of anaesthesia were recorded.
  
  
  RESULTS
  The maximum cephalad sensory block level and the incidence of hypotension decreased as the density of SAS fell (T1, T2, T4 and T6, P < 0.001; 48.3, 30, 13.3 and 10.3%, P = 0.003). The incidence of shivering reduced with decreasing density of SAS (P < 0.05). There was no significant difference in the quality of anaesthesia (efficacy of motor block and sensory block) between the groups (P > 0.05).
  
  
  CONCLUSIONS
  Compared with conventional 8% glucose hyperbaric SAS, marginally hyperbaric (0.5 or 0.33% glucose) low-dose bupivacaine solutions led to a significantly lower height of cephalad spread and incidence of hypotension with no impact on the efficacy of spinal anaesthesia for caesarean section.
authors.affiliation: From the Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Department of Anesthesia, Qilu Hospital (Qingdao), Shandong University, Qingdao (W-XT), Department of Anesthesia, Qilu Hospital, Shandong University, Jinan (J-JL), Department of Anesthesia, Dongying People's Hospital Affiliated to Binzhou Medical University, Dongying (H-MB) and Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China (Z-JF).
authors.forename: Wen-Xi
authors.initials: WX
authors.lastname: Tang
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Bu
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Fu
mesh_terms: D000759:Adjuvants, Anesthesia; D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009407:Nerve Block; D010146:Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012768:Shivering / Q000187:drug effects; D017409:Sufentanil
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine