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OBSTETRIC ANESTHESIA

Comparison of 9 mg of Intrathecal Plain and Hyperbaric Bupivacaine Both with Fentanyl for Cesarean Delivery

Anesthesia Research Group, Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence and reprint requests to Johanna Sarvela, MD, PhD, Anesthesia Research Group, Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, PO Box 140, FIN-00029 HYKS. Address e-mail to johanna.sarvela{at}huch.fi

We randomized 76 parturients to a double-blinded trial to receive spinal anesthesia with either hyperbaric or plain bupivacaine 9 mg with fentanyl 20 µg for elective cesarean delivery. A combined spinal-epidural technique was used. The onset and duration of anesthesia (absence of pinprick sensation), analgesia (absence of sharp sensation to pinprick), and absence of cold sensation and motor block were measured until recovery from the motor block. No major differences were seen in onset or duration of anesthesia between the groups. Motor block, however, vanished faster when hyperbaric bupivacaine was used (P < 0.05). The level of anesthesia (no pinprick sensation) required for painless operation was at dermatome T5. At this time, the absence of cold sensation ranged from dermatome T1 to C3. The median time for the anesthesia to reach dermatome T5 was 10 min. Cervical spread of pinprick anesthesia was noted in six patients, and five needed supplementary analgesics during surgery (not significant between the groups). Maternal satisfaction was good. Nine milligrams of either plain or hyperbaric bupivacaine with fentanyl intrathecally provided similar onset, depth, and duration of sensory anesthesia for cesarean delivery with good maternal satisfaction. Motor block developed and diminished faster with the hyperbaric solution.

Implications: Nine milligrams of either plain or hyperbaric bupivacaine with fentanyl intrathecally provided similar onset, depth, and duration of sensory anesthesia for cesarean delivery with good maternal satisfaction. Motor block developed and diminished faster with the hyperbaric solution.

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