How low can we go? A double-blinded randomized controlled trial to compare bupivacaine 5 mg and bupivacaine 7.5 mg for spinal anesthesia in cesarean delivery in Indonesian population

Susilo Chandra, Alfan Mahdi Nugroho, Henry Agus, Astrid Pratidina Susilo

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Maternal hypotension in cesarean delivery related to spinal anesthesia results in increasing morbidity of both mothers and children. Studies show that low dose spinal anesthesia was able to prevent hypotension while providing adequate analgesia. However, the dose used in those studies varies and this leaves the debate of the dose scheme of spinal anesthesia open. Objectives: This study aimed to compare the effectiveness of 5mghyperbaric bupivacaine 0.5% and 25 mcg of fentanyl with 7.5mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl to prevent hypotension in spinal anesthesia for cesarean delivery. Methods: This study was a double-blinded randomized controlled trial of 112 mothers undergoing cesarean delivery with spinal anesthesia. The intervention group received 5mgbupivacaine and 25 mcg fentanyl. The comparison group received of 7.5mgbupivacaine and 25 mcg fentanyl. The primary outcome was the incidence of hypotension. The adequacy of anesthesia, duration of recovery from the motoric block, the quality of analgesia as perceived by patients and surgeons, and the side effects of anesthesia were also recorded. Results: There was no difference of effectiveness to prevent hypotension in both groups. The 7.5 mgdose provided better adequacy of anesthesia as reflected in lower incidence of conversion into general anesthesia. More surgeons reported adequacy of relaxation in the 7.5 mg dose. The 5 mg dose offered faster motoric recovery and fewer side effects. Conclusions: The dose of 7.5 mg hyperbaric bupivacaine 0.5% and 25 mcg of fentanyl can be used as a prevention measure against hypotension due to spinal anesthesia cesarean delivery.

Original languageEnglish
Article numbere91275
JournalAnesthesiology and Pain Medicine
Volume9
Issue number2
DOIs
Publication statusPublished - Apr 2019

Keywords

  • Cesarean delivery
  • Low-dose bupivacaine
  • Spinal anesthesia

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