title: Comparison of low doses of intrathecal bupivacaine in combined spinal epidural anaesthesia with epidural volume extension for caesarean delivery.
abstract: OBJECTIVE
  This study aims to compare relative efficacy of three different doses of intrathecal bupivacaine in combined spinal epidural anaesthesia (CSEA) for caesarean delivery.
  
  
  METHODS
  In a double blinded manner, 204 cases were randomized into three groups: I, II, and III to receive a dose of 4, 5.5, and 7 mg of hyperbaric bupivacaine with a fixed dose of 25 μg fentanyl intrathecally, and Dextran 40 w/v 10 mL given for epidural volume extension (EVE), in CSEA. Our primary outcome was the number of effective doses. The block characteristics and side effects were also monitored.
  
  
  RESULTS
  Out of 198 patients completing the study, 53, 63, and 65 in group I, II and III had effective doses. Mean Pi (probability of an effective dose) in group I, II, and III, was 0.81, 0.95, and 0.97, respectively. The Pb (superiority of one group over the other) of group II and III was higher than group I. The maximal sensory block height in group II and III (T2) was higher than group I (T3), with a shorter time required to achieve the same. Group I and II exhibited lesser motor blockade, lesser hypotension with early recovery as compared to group III. No significant adverse effects were observed between the groups.
  
  
  CONCLUSIONS
  The intermediate dose of bupivacaine (5.5 mg) provided safe and effective anaesthesia for caesarean delivery with an additional advantage of lesser episodes of hypotension and partial motor blockade in CSEA.
authors.affiliation: Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jain
authors.affiliation: Department of Anaesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Singh
authors.affiliation: Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Pranav
authors.initials: P
authors.lastname: Bansal
authors.affiliation: Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Bashir
authors.initials: B
authors.lastname: Ahmed
authors.affiliation: Department of Anaesthesia, Teerthankar Mahaveer Medical College, Moradabad, Uttar Pradesh, India.
authors.forename: Satyavir S
authors.initials: SS
authors.lastname: Dhama
keywords: Bupivacaine; Dextran 40; combined spinal-epidural anaesthesia; epidural volume extension (EVE); fentanyl