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Zhao YP, Zhang XF, Qian J, Xiao F, Chen XZ. Randomized Double-Blind Study of the Effect of Injectate Temperature on Intrathecal Bupivacaine Dose Requirement in Spinal Anesthesia for Cesarean Delivery. Anesth Analg 2024:00000539-990000000-00843. [PMID: 38870069 DOI: 10.1213/ane.0000000000007095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND Increasing the temperature of intrathecal local anesthetics has been shown to increase the speed of onset and block height of spinal anesthesia. However, how this influences dose requirement has not been fully quantified. The aim of this study was to determine and compare the effective dose for anesthesia for cesarean delivery in 50% of patients (ED50) of intrathecal bupivacaine given at temperatures of 37 °C (body temperature) or 24 °C (room temperature). METHODS Eighty healthy parturients having elective cesarean delivery under combined spinal-epidural anesthesia were randomly assigned to receive intrathecal hyperbaric bupivacaine stored at 37 °C (body temperature group) or 24 °C (room temperature group). The first subject in each group received a bupivacaine dose of 10 mg. The dose for each subsequent subject in each group was varied with an increment or decrement of 1 mg based on the response (effective or noneffective) of the previous subject. Patients for whom the dose was noneffective received epidural supplementation after data collection with lidocaine 2% as required until anesthesia was sufficient for surgery. Values for ED50 were calculated using modified up-down sequential analysis with probit analysis applied as a backup sensitivity analysis. These values were compared and the relative mean potency was calculated. RESULTS The ED50 (mean [95% confidence interval, CI]) of intrathecal hyperbaric bupivacaine was lower in the body temperature group (6.7 [5.7-7.6] mg) compared with the room temperature group (8.1 [7.7-8.6] mg) (P < .05). The relative potency ratio for intrathecal bupivacaine for the room temperature group versus the body temperature group was 0.84 (95% CI, 0.77-0.93). CONCLUSIONS Warming hyperbaric bupivacaine to body temperature reduced the dose requirement for spinal anesthesia for cesarean delivery by approximately 16% (95% CI, 7%-23%).
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Affiliation(s)
- Yan-Ping Zhao
- From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital; Jiaxing City, China
| | - Xu-Feng Zhang
- From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Anesthesia, Ningbo Medical Centre Lihuili Hospital; Ningbo City, China
| | - Jing Qian
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital; Jiaxing City, China
| | - Fei Xiao
- Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital; Jiaxing City, China
| | - Xin-Zhong Chen
- From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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2
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Besha A, Zemedkun A, Tadesse M, Hailu S, Mossie A, Shiferaw A, Angasa D, Adamu Y. Effects of Hyperbaric and Isobaric Bupivacaine on Hemodynamic Profiles and Block Characteristics Among Parturients Undergoing Elective Cesarean Section Under Spinal Anesthesia: A Randomized Controlled Trial. J Pain Res 2023; 16:3545-3558. [PMID: 37881235 PMCID: PMC10595164 DOI: 10.2147/jpr.s428314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Cesarean section (CS) is a surgical procedure where the baby is delivered through incisions made in the abdomen and uterus. Bupivacaine is a widely recognized local anesthetic available in different baricity and it is frequently used for spinal anesthesia. The baricity of bupivacaine impacts hemodynamic profiles and block characteristics. Objective To compare the effects of hyperbaric and isobaric bupivacaine on hemodynamic profiles and block characteristics among parturients undergoing elective cesarean section under spinal anesthesia at Dilla University Referral Hospital. Methods 64 pregnant mothers scheduled for elective cesarean section under spinal anesthesia were randomly assigned to two groups: Group A received a dose of 12.5 mg of isobaric bupivacaine (n = 32), Group B received a dose of 12.5 mg of hyperbaric bupivacaine (n = 32). Prior to conducting the study, the necessary ethical approvals were obtained. For comparing numerical variables between the two groups, the independent Sample t-test or Mann-Whitney U-test was employed as needed. Repeated measurements were analyzed using mixed ANOVA. Categorical variables were assessed using either the chi-square test or Fisher's exact test. Statistical significance was set at P < 0.05, with a power of 90%. Results The mean Systolic Blood Pressure (SBP), Diastolic Blood pressure (DBP), and Mean Arterial Blood Pressure (MAP) showed significant decrement in the group receiving isobaric spinal anesthesia compared to those receiving hyperbaric bupivacaine. The decrement was observed from the 6th to 30th minute (p<0.05). Furthermore, the hyperbaric group had a faster onset time for achieving the maximum sensory block, with a median time of 3 (1) min compared to 4 (2) mins in the isobaric group (p<0.001). Conclusion and Recommendation We conclude that hyperbaric bupivacaine provides stable intraoperative hemodynamic parameters and an earlier onset of block than isobaric bupivacaine. Therefore, we recommend clinicians to use hyperbaric bupivacaine for cesarean delivery.
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Affiliation(s)
- Aschalew Besha
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Abebayehu Zemedkun
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Muhiddin Tadesse
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Seyoum Hailu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Addisu Mossie
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Adanech Shiferaw
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Dugo Angasa
- Department of Anesthesia, College of Health Sciences and Medicine, Hawassa University, Hawassa, Ethiopia
| | - Yayeh Adamu
- Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesth Pain Med (Seoul) 2023; 18:349-356. [PMID: 37919919 PMCID: PMC10635856 DOI: 10.17085/apm.23031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 11/04/2023] Open
Abstract
Spinal anesthesia (SA) is gaining recognition as a safe and efficacious regional alternative to general anesthesia for elective lumbar surgery. However, unfamiliarity with management issues related to its use has limited the adoption of awake spine surgery, despite its benefits. Few centers in the United States routinely offer SA for elective lumbar surgery, and a comprehensive workflow to standardize SA for lumbar surgery is lacking. In this article, we examine recent literature on the use of SA in lumbar surgery, review the experience of our institution with SA in lumbar surgery, and provide a cohesive outline to streamline the implementation of SA from the perspective of the anesthesiologist. We review the critical features of SA in contemporary lumbar surgery, including selection of patients, methods of SA, intraoperative sedation, and management of several important technical considerations. We aimed to flatten the learning curve to improve the availability and accessibility of the technique for eligible patients.
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Affiliation(s)
| | - Benayas Begashaw
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Penny Liu
- Department of Anesthesiology, Tufts Medical Center, Boston, MA, USA
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4
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Kranke P, Geldner G, Kienbaum P, Gerbershagen HJ, Chappell D, Wallenborn J, Huljic S, Koch T, Keller T, Weber S, Kunitz O, Linstedt U, Eberhart LHJ. Treatment of spinal anaesthesia-induced hypotension with cafedrine/theodrenaline versus ephedrine during caesarean section: Results from HYPOTENS, a national, multicentre, prospective, noninterventional study. Eur J Anaesthesiol 2021; 38:1067-1076. [PMID: 33625060 PMCID: PMC8452326 DOI: 10.1097/eja.0000000000001474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Germany, hypotension induced by spinal anaesthesia is commonly treated with a combination of cafedrine hydrochloride (C, 200 mg) and theodrenaline hydrochloride (T, 10 mg) in 2 ml. We compared the effectiveness of C/T with ephedrine. OBJECTIVES The primary objectives were to assess the speed of onset and the ability to restore blood pressure without an increase in heart rate. Secondary objectives were to evaluate maternal/foetal outcomes and the number of required additional boluses or other additional measures. DESIGN HYPOTENS was a national, multicentre, prospective, open-label, two-armed, noninterventional study comparing C/T with ephedrine in two prospectively defined cohorts. This study relates to the cohort of patients receiving spinal anaesthesia for caesarean section. SETTING German hospitals using either C/T or ephedrine in their routine clinical practice. PATIENTS Women aged at least 18 years receiving spinal anaesthesia for caesarean section. INTERVENTIONS Bolus administration of C/T or ephedrine at the discretion of the attending anaesthesiologist. MAIN OUTCOME MEASURES Endpoints within 15 min after initial administration of C/T or ephedrine were area under the curve between the observed SBP and the minimum target SBP; and incidence of newly occurring heart rate of at least 100 beats min-1. RESULTS Although effective blood pressure stabilisation was achieved with both treatments, this effect was faster and more pronounced with C/T (P < 0.0001). The incidence of tachycardia and changes in heart rate were higher with ephedrine (P < 0.01). Fewer additional boluses (P < 0.01) were required with C/T. Although favourable neonatal outcomes were reported in both groups, base deficit and lactate values were greater with ephedrine (P < 0.01). Physician satisfaction was higher with C/T. CONCLUSIONS After C/T, tachycardia was not a problem, providing an advantage over ephedrine. Fewer additional boluses were required with C/T, suggesting greater effectiveness. An increased base deficit with ephedrine suggests reduced oxygen supply or increased demands in foetal circulation. TRIALS REGISTRATION Clinicaltrials.gov: NCT02893241, German Clinical Trials Register: DRKS00010740.
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Affiliation(s)
- Peter Kranke
- From the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg (PK), the Clinic for Intensive Care, Emergency Medicine and Pain Therapy, Hospital Ludwigsburg, Ludwigsburg (GG), the Department of Anaesthesiology, University Hospital Düsseldorf, Düsseldorf (PK), the Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Marienhospital Gelsenkirchen, Gelsenkirchen (HJG), the Department of Anaesthesiology and Intensive Care Medicine, Klinikum Frankfurt Höchst, Frankfurt (DC), the Department of Anaesthesiology and Intensive Care, HELIOS Clinic Aue, Aue (JW), ratiopharm GmbH, Ulm (SH), the Department of Anaesthesiology & Intensive Care, Philipps University Marburg, Marburg (TK, LHJE), ACOMED Statistik, Leipzig (TK, SW), the Department of Anaesthesia, Emergency and Intensive Care Medicine, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier (OK), the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Diako Hospital, Flensburg, Germany (UL) on behalf of the HYPOTENS study group
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5
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Okucu F, Aksoy M, Ince I, Aksoy AN, Dostbıl A, Ozmen O. Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions. Anaesthesist 2021; 70:30-37. [PMID: 34159412 DOI: 10.1007/s00101-021-00995-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients. OBJECTIVE This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section. MATERIAL AND METHODS In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded. RESULTS In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04). CONCLUSION Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.
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Affiliation(s)
- Fatma Okucu
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey. .,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.
| | - Ilker Ince
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Ayse Nur Aksoy
- Department of Obstetrics and Gynecology, Erzurum Regional Training and Research Hospital, University of Health Sciences, Erzurum, Turkey
| | - Aysenur Dostbıl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Ozgur Ozmen
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
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Pandit JJ, McGuire N. Unlicensed intravenous lidocaine for postoperative pain: always a safer 'licence to stop' than to start. Anaesthesia 2020; 76:156-160. [PMID: 33141932 DOI: 10.1111/anae.15286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- J J Pandit
- Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
| | - N McGuire
- Medical Devices, Medicines and Healthcare Products Regulatory Agency, London, UK
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7
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Limratana P, Kiatchai T, Somnuke P, Prapakorn P, Suksompong S. The effect of baricity of intrathecal bupivacaine for elective cesarean delivery on maternal cardiac output: a randomized study. Int J Obstet Anesth 2020; 45:61-66. [PMID: 33121884 DOI: 10.1016/j.ijoa.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hemodynamic instability during spinal anesthesia for cesarean delivery is associated with adverse maternal and fetal outcomes. Plain and hyperbaric bupivacaine are commonly used for cesarean delivery, however, their distinctive pharmacologic properties may affect maternal hemodynamic profiles differently. The aim of this study was to compare hemodynamic profiles using a suprasternal Doppler cardiac output (CO) monitor in healthy term parturients randomized to receive plain or hyperbaric bupivacaine for cesarean delivery. METHODS One hundred-and-sixty-eight healthy parturients scheduled for elective cesarean delivery were randomly assigned to receive 10.9 mg of intrathecal 0.5% plain or hyperbaric bupivacaine, both with 0.2 mg morphine. The primary outcome was CO change after spinal anesthesia. Secondary outcomes were the incidence of hypotension, vasopressor use, and conversion to general anesthesia. RESULTS The mean (±SD) CO at baseline, 1 min and 5 min after spinal anesthesia, and after placental delivery was 4.6 ± 1.2, 5.4 ± 1.3, 5.1 ± 1.4, and 6.4 ± 1.7 L/min in the plain bupivacaine, and 4.5 ± 1.1, 5.2 ± 1.3, 4.9 ± 1.3, and 6.2 ± 1.9 L/min in the hyperbaric bupivacaine group. There were no significant differences in CO, mean arterial pressure, or systemic vascular resistance. Incidences of hypotension, vasopressor and supplemental analgesic use, and conversion to general anesthesia, were not different between groups. CONCLUSIONS Cardiac output changes after plain or hyperbaric bupivacaine were not different in term parturients undergoing spinal anesthesia for cesarean delivery. Further studies comparing block quality and the rate of conversion to general anesthesia are required.
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Affiliation(s)
- P Limratana
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - T Kiatchai
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - P Somnuke
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - P Prapakorn
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - S Suksompong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
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8
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Weiniger CF. What's new in obstetric anesthesia in 2018? Int J Obstet Anesth 2020; 42:99-108. [PMID: 32278531 DOI: 10.1016/j.ijoa.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
The Gerard W. Ostheimer Lecture presented at the annual meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) is a one-year summary of the literature published in domains of interest to anesthesiologists who manage and care for obstetric patients. One individual is asked to review the literature and present the lecture. This manuscript summarizes aspects of the Gerard W. Ostheimer Lecture presented at the 2019 SOAP meeting; the relevant literature from 2018 was summarized. The topics included in this review are maternal morbidity, antibiotic prophylaxis, anaphylaxis, the Lancet series on increasing cesarean delivery rates, the Robson Ten-Group Classification System, pelvic floor disorders, timing of delivery in nulliparous women, placenta accreta disorders, anesthesia for cesarean delivery, labor analgesia (including parturients with thrombocytopenia and tattoos, and epidural maintenance with the programmed intermittent epidural bolus technique), ultrasound use in obstetric anesthesia, and drugs in pregnancy.
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Affiliation(s)
- C F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Israel.
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9
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Schubert AK, Wiesmann T, Neumann T, Annecke T. [Selection of the optimal anesthesia regimen for cesarean section]. Anaesthesist 2020; 69:211-222. [PMID: 32076739 DOI: 10.1007/s00101-020-00741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Approximately one third of all children in Germany are delivered by cesarean section. Depending on the individual patient's condition and the situation, the anesthesiologist has to choose between a general or a regional anesthesia regimen. The decisive factor for the selection is the obstetric urgency (decision-delivery time) after ascertainment of the indications. Furthermore, the need for postoperative analgesia varies depending on the chosen anesthesia regimen.
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Affiliation(s)
- A-K Schubert
- Klinik für Anästhesie und Intensivtherapie, Philipps-Universität, Marburg, Deutschland
| | - T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Philipps-Universität, Marburg, Deutschland
| | - T Neumann
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - T Annecke
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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10
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Uppal V, Retter S, Casey M, Sancheti S, Matheson K, McKeen DM. Efficacy of Intrathecal Fentanyl for Cesarean Delivery. Anesth Analg 2020; 130:111-125. [DOI: 10.1213/ane.0000000000003975] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Liu J, Huang S, Sun S, Sun X, Wang T. Comparison of nalbuphine, ondansetron and placebo for the prevention of shivering after spinal anaesthesia for urgent caesarean delivery: a randomised double-blind controlled clinical trial. Int J Obstet Anesth 2019; 42:39-46. [PMID: 31734098 DOI: 10.1016/j.ijoa.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/28/2019] [Accepted: 10/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shivering is a common complication of caesarean delivery with neuraxial anaesthesia. The effective prevention and treatment of shivering, especially before delivery, is important and difficult. We tested the hypothesis that prophylactic nalbuphine and ondansetron can prevent post-spinal anaesthesia shivering in parturients undergoing urgent caesarean delivery. METHODS Sixty parturients scheduled for urgent caesarean delivery before spinal anaesthesia were selected and divided randomly into three groups. After peripheral venous catheterisation, parturients were given intravenous nalbuphine 0.08 mg/kg (group N), ondansetron 8 mg (group O), or normal saline (group C). RESULTS The incidence of shivering and of severe (grade ≥3) shivering was significantly lower in group N (15% and 15%, respectively) than in group C (80% and 65%) before delivery (P <0.001 and P=0.003); and significantly less shivering was observed in group N than in group C in the first 30 min after anaesthesia (P=0.001). Up to 60 min after anaesthesia, the incidence of grade ≥3 shivering remained lowest in group N (P=0.003). According to the data during the period from anaesthesia until delivery, the number needed-to-treat for nalbuphine was 1.54 (95%CI 1.13 to 2.41). No significant differences were found between groups O and N or groups O and C at any time. The incidence of dizziness in group N was significantly higher than that of groups O or C (P=0.009). CONCLUSION Nalbuphine 0.08 mg/kg can prevent post-spinal anaesthesia shivering in parturients undergoing urgent caesarean delivery but causes transient dizziness, while ondansetron 8 mg had no significant effect.
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Affiliation(s)
- J Liu
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - S Huang
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - S Sun
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - X Sun
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - T Wang
- Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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12
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Kwikiriza A, Kiwanuka JK, Firth PG, Hoeft MA, Modest VE, Ttendo SS. The analgesic effects of intrathecal morphine in comparison with ultrasound-guided transversus abdominis plane block after caesarean section: a randomised controlled trial at a Ugandan regional referral hospital. Anaesthesia 2018; 74:167-173. [PMID: 30383289 DOI: 10.1111/anae.14467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
Both transversus abdominis plane block and intrathecal morphine may produce prolonged postoperative analgesia, but the respective clinical outcomes of these anaesthetic techniques in resource-limited settings are not well described. We randomly assigned patients undergoing caesarean section to receive a hyperbaric bupivacaine (10 mg) spinal anaesthetic followed by an ultrasound-guided transversus abdominis plane block, or a hyperbaric bupivacaine (10 mg) spinal anaesthetic with 100 mcg intrathecal morphine, followed by a postoperative sham block. Supplemental postoperative analgesia included self-administered oral diclofenac 50 mg and paracetamol 1 g every 8 h. Numerical pain rating scores, the need for rescue medication, side-effects and patient satisfaction were recorded at 8, 16 and 24 h. We enrolled a total of 130 patients, with 65 women in each group. The mean numerical rating score for intrathecal morphine vs. transversus abdominis plane blocks at 8 h were: at rest, 2.5 vs. 3.1 (p = 0.04); with coughing, 4.3 vs. 4.8 (p = 0.07); and with movement, 3.6 vs. 4.2 (p = 0.06). At 16 h, respective scores were: 2.9 vs. 3.1 (p = 0.40) at rest; 4.0 vs. 4.3 (p = 0.19) with coughing; and 4.8 vs. 5.0 (p = 0.33) with movement. At 24 h, the respective scores were: 2.9 vs. 2.3 (p = 0.01); 4.6 vs. 4.2 (p = 0.04) with coughing; and 3.9 vs. 3.4 (p = 0.02) with movement. The need for rescue medication and the incidence of pruritis, sedation and nausea and vomiting were similar in both groups. Patient satisfaction with pain control was similar in both groups, with the majority of patients reporting satisfaction as good or excellent. Intrathecal morphine and transversus abdominis plane block provided clinically similar outcomes for pain relief after caesarean section.
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Affiliation(s)
- A Kwikiriza
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - J K Kiwanuka
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
| | - P G Firth
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M A Hoeft
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - V E Modest
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S S Ttendo
- Department of Anaesthesia and Critical Care, Mbarara Regional Referral Hospital, Mbarara University of Science and Technology, Mbarara, Uganda
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Sng BL, Han NLR, Leong WL, Sultana R, Siddiqui FJ, Assam PN, Chan ES, Tan KH, Sia AT. The baricity of plain bupivacaine - a reply. Anaesthesia 2018; 73:908-909. [DOI: 10.1111/anae.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B. L. Sng
- KK Women's and Children's Hospital; Singapore
| | | | - W. L. Leong
- KK Women's and Children's Hospital; Singapore
| | - R. Sultana
- KK Women's and Children's Hospital; Singapore
| | | | - P. N. Assam
- KK Women's and Children's Hospital; Singapore
| | - E. S. Chan
- KK Women's and Children's Hospital; Singapore
| | - K. H. Tan
- KK Women's and Children's Hospital; Singapore
| | - A. T. Sia
- KK Women's and Children's Hospital; Singapore
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15
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Hollis N. Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section. Anaesthesia 2018; 73:790-791. [PMID: 29747229 DOI: 10.1111/anae.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- N Hollis
- Dorset County Hospital, Dorchester, UK
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