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. 2016 May-Aug;10(2):312-8.
doi: 10.4103/0259-1162.171447.

Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension

Amr Aly Ismail Keera  1 , Ali Mohamed Ali Elnabtity  2
Affiliations

Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension

Amr Aly Ismail Keera et al. Anesth Essays Res. 2016 May-Aug.

Abstract

Background: Multiple trials have been tried to prevent hypotension during spinal anesthesia. However, the drug choice and mode of administration is still a matter of debate.

Objectives: To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl separately to standard injection of mixed fentanyl with hyperbaric bupivacaine.

Settings and design: A randomized, controlled clinical trial.

Patients and methods: One hundred twenty-four parturient scheduled for elective cesarean section were randomly allocated into two groups, each 62 parturient: Group M received spinal anesthesia using 10 mg bupivacaine 0.5% premixed with 25 μg fentanyl in the same syringe and Group S received 25 μg fentanyl in one syringe and 10 mg bupivacaine 0.5% without barbotage in a second syringe.

Results: Patients with intraoperative pain that was controllable without the need for a shift to general anesthesia was significantly lower in Group S (3.2%) than in Group M (16.1%). The frequency of hypotension was significantly lower in Group S compared to Group M (P < 0.05). Time till the onset of sensory block was nonsignificantly shorter with nonsignificantly higher mean level of maximal sensory block in Group S compared to Group M (P > 0.05). There was no significant difference in the time till occurrence of hypotension, duration of hypotension, mean dose of ephedrine used for the treatment of hypotension and frequency of patients developed itching between the groups (P > 0.05).

Conclusion: Separate intrathecal injection of fentanyl and hyperbaric bupivacaine provided a significant improvement in the quality of sensory block and significant reduction of the frequency of hypotension compared to injection of mixed medications.

Keywords: Bupivacaine; cesarean section; fentanyl; separate; spinal anesthesia.

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Figures

Figure 1
Figure 1
CONSORT flow diagram
Figure 2
Figure 2
Frequency of hypotension in both groups. *Means statistically significant
Figure 3
Figure 3
Time till the onset of hypotension and sensory onset in both study groups
Figure 4
Figure 4
Patients with fair block needed supplemental analgesics. *Means statistically significant
See this image and copyright information in PMC

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