title: Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial.
abstract: BACKGROUND
  After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S.
  
  
  METHODS
  In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher's exact test, one-way ANOVA, Mann-Whitney U-test, and student's t test.
  
  
  RESULTS
  The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant (40.47% vs. 61.9%, P=0.08). The duration of hypotension was shorter in the study group (1.6±7.8 min vs. 7.4±12.5 min, P=0.004). The dose of ephedrine was lower in the study group (2.4±6.6 mg vs. 5.3±10.7 mg, P=0.006). The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 (16.66%) of hyperbaric groups (P=0.006). None of the neonates had Apgar score≤7 at 5 min of delivery (P=1.0). Sensory and motor block duration was shorter in the study group (P=0.01).
  
  
  CONCLUSIONS
  Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S.Trial Registration Number:IRCT201401287013N7.
authors.affiliation: Department of Anesthesia, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Simin
authors.initials: S
authors.lastname: Atashkhoei
authors.affiliation: Department of Anesthesia, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Naghi
authors.initials: N
authors.lastname: Abedini
authors.affiliation: Department of Anesthesia, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hojjat
authors.initials: H
authors.lastname: Pourfathi
authors.affiliation: Department of Anesthesia, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali Bahrami
authors.initials: AB
authors.lastname: Znoz
authors.affiliation: Department of Anesthesia, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Pouya Hatami
authors.initials: PH
authors.lastname: Marandi
keywords: Anesthesia; Bupivacaine; Cesarean section; Hypotension; Spinal