Minimum effective volume of bupivacaine in spinal anesthesia for elective cesarean section. Does it differ with height? A non-randomized parallel study
Background: Spinal anesthesia is the preferred anesthetic technique for elective Cesarean deliveries. Hypotension is the most common side-effect and has both maternal and neonatal consequences. This study aims to determine the minimum effective volume of hyperbaric bupivacaine 0.5% with fentanyl in 90% of parturients (MEV90) with different height groups undergoing cesarean section. Patients and Methods: Parturients scheduled for elective cesarean section under spinal anesthesia were divided into 3 groups according to their height (ht), group 1 including those with height between 150 and 159cm, group 2 with ht between 160 and 169cm and group 3 patients with ht between 170 and 179cm. The starting volumes were 2.5, 2.6 and 2.7ml respectively. We identified 3 responses to the injected volume and the volume given to each parturient depends on the response of the previous one. Every patient was assessed for hemodynamics, degree of sensory and motor blocks. Results: Demographically, all the groups were comparable. The study was completed after recruiting 201 patients. The MEV90 for group 1 was approximately 2.62ml (95% CI, 2.59-2.65ml), 2.76ml for group 2 (95% CI, 2.73-2.77ml) and 2.80 for group 3 (95% CI, 2.76-2.81ml). None of the babies had an Apgar score below 7 at 1 and 5min after birth in the 3 groups. Conclusion: The volumes of hyperbaric 0.5% bupivacaine with fentanyl which produced effective spinal block in 90% of parturients undergoing cesarean deliveries were 2.62, 2.76 and 2.8ml in the 3 different height groups respectively.
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