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LETTER TO THE EDITOR

Combined Spinal-Epidural Anesthesia for Cesarean Delivery: The Dose-Dependent Effects of Hyperbaric Bupivacaine on Maternal Hemodynamics

Department of Anesthesiology; University of Virginia Health Systems; Charlottesville, Virginia; pjb8y{at}virginia.edu

To the Editor:

Van de Velde et al. (1) convincingly demonstrate that just 6.5 mg of hyperbaric bupivicaine combined with 2.5 µg of sufentanil can provide anesthesia for cesarean delivery while reducing the incidence of hypotension associated with higher doses. However, such doses are associated with significantly decreased duration, as their study demonstrates. Patients in their LOW-group had slower onset of T3 block, shorter duration of anesthesia, and increased requirements for analgesia after delivery. An epidural catheter was required to successfully complete the surgical anesthesia.

What exactly has been gained by this approach and what is the associated cost? Are we better off using a technique that requires longer to place, longer for onset of anesthesia, and an indwelling epidural catheter to complete the operation and provide postoperative analgesia? Is this better than simply using a higher dose of local anesthetic, and treating hypotension with judiciously titrated vasopressors (2–4)?

REFERENCES

1. Van de Velde M, Van Schoubroeck D, Jani J, et al. Combined spinal-epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg 2006;103:187–90.[Abstract/Free Full Text]
2. Lee A, Kee WDN, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg 2004;98:483–90.[Abstract/Free Full Text]
3. Sharma SK, Gajraj NM, Sidawi JE. Prevention of hypotension during spinal anesthesia: a comparison of intravascular administration of hetastarch versus lactated Ringer’s solution. Anesth Analg 1997;84:111–4.[Abstract]
4. Kee WDN, Khaw KS, Lee BB, et al. A dose–response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2000;90:1390–5.[Abstract/Free Full Text]

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