title: Hyperbaric versus plain bupivacaine for spinal anesthesia for cesarean delivery.
abstract: BACKGROUND
  Bupivacaine is an amide local anesthetic used in hyperbaric and plain forms administered as spinal anesthesia for cesarean delivery. In this systematic review, we summarized the effectiveness and safety of hyperbaric versus plain bupivacaine in providing anesthesia for cesarean delivery. We considered the adequacy of anesthesia for completion of cesarean delivery and the need for interventions to treat complications.
  
  
  METHODS
  We searched the CENTRAL, MEDLINE, and EMBASE databases. We imposed no language restriction. We included all randomized controlled trials involving patients undergoing spinal anesthesia for elective cesarean delivery that compared the use of hyperbaric bupivacaine with plain bupivacaine.
  
  
  RESULTS
  We included 6 studies with a total of 394 patients in this review. These studies have small sample size, few observed events, differences in methodology, and insufficient information pertaining to assessment of risk of bias. This prevented us from calculating pooled estimates. Results show that there is no compelling evidence in favor of the use of intrathecal plain or hyperbaric bupivacaine for spinal anesthesia for cesarean delivery.
  
  
  CONCLUSIONS
  There is a lack of clear evidence regarding the superiority of hyperbaric compared with plain bupivacaine for spinal anesthesia for cesarean delivery. The need for conversion to general anesthesia because of failed spinal anesthesia is an important clinical outcome, but current data are insufficient to compare spinal anesthesia induced with hyperbaric compared with plain bupivacaine for this outcome. Further research is required.
authors.affiliation: From the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics and Gynaecology, and Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore; and Clinical Research Institute, Singapore, Singapore.
authors.forename: Alex Tiong
authors.initials: AT
authors.lastname: Heng Sia
authors.forename: Kok Hian
authors.initials: KH
authors.lastname: Tan
authors.forename: Ban Leong
authors.initials: BL
authors.lastname: Sng
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Lim
authors.forename: Edwin S Y
authors.initials: ESY
authors.lastname: Chan
authors.forename: Fahad Javaid
authors.initials: FJ
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D000399:Air Pressure; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine