Combined use of low-dose bupivacaine, colloid preload and wrapping of the legs for preventing hypotension in spinal anaesthesia for caesarean section

Abstract

We tested the hypothesis that using a combination of methods would result in a greater reduction in the incidence of hypotension due to spinal anaesthesia in caesarean sections compared with using each method on its own. A total of 120 patients were randomly allocated to the following four treatment groups: 10 mg bupivacaine 0.5% intrathecally plus 500 ml Ringer lactate solution (group B); 4 mg bupivacaine 0.5% plus 25 mug fentanyl plus 500 ml Ringer lactate solution (group F); 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously (group G); and 4 mg bupivacaine 0.5% plus 25 mug fentanyl intrathecally plus 500 ml Gelofusine intravenously plus tight wrapping of the lower extremities with an Esmarch bandage (group E). The Esmarch bandage was only loosely applied in groups B, F and G. Hypotension was detected in 100% of the patients in group B compared with 70.0%, 46.7% and 23.3% of those in groups F, G and E, respectively. Hypotension was thus reduced by using a combination of several methods.