4^th International Anesthesia and Pain Medicine Conference

Background & Objective: Spinal anesthesia using hyperbaric bupivacaine has become the preferred technique in cesarean section because it provides rapid anesthesia and analgesia. In many years, the conventional dose of bupivacaine is associated with hypotension that increases maternal and neonatal morbidity and mortality. Fentanyl is known to have a selective effect on the spinal cord which it enhances the action of bupivacaine on the efferent pathways but without an effect on the sympathetic pathways. The main objective of this study is to determine if low dose bupivacaine plus fentanyl is associated with less maternal hypotension compared to conventional dose bupivacaine from induction to delivery of the fetus in cesarean section. Methods: A total of 50 pregnant patients between the age of 18 and 45 years of American Society of

Anesthesiologists (ASA) physical status II for cesarean section are included. Study group-A received a total volume of 2-3 ml with a combination of 15 mcg fentanyl and less than or equal to 10 mg of 0.5% hyperbaric bupivacaine, whereas group-B also received 2-3 ml of 0.5% hyperbaric bupivacaine more than 10 mg only. The baseline demographics (age, weight, height, body mass index), baseline and intraoperative Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Maternal Heart Rate (MHR), Oxygen Saturation (O2

Sat) and Respiratory Rate (RR), duration of the procedure, number of hypotensive episodes and number of vasopressor used from induction to the delivery of the fetus and the APGAR score were all obtained and analyzed in this study. Results: Results after 1 minute of anesthesia administrations showed bupivacaine only group had significantly lower SBP (81.56±7.16 vs. 94.64±11.01, p-value<0.001) and DBP (51.8±9.33 vs. 63.76±9.1, p-value=01)

compared to bupivacaine plus fentanyl group. The bupivacaine only group presented with more episodes of hypotension (1, range 0-3 vs. 0, range 0-1, p value<0.001), thus with more vasopressor use as well (20 vs. 3,p-value<0.001). No notable difference in the APGAR score between the two anesthetic groups and none of the newborns delivered had an APGAR score lower than 7 at either 1 or 5 minutes of life. Conclusion: Spinal anesthesia for cesarean section using less than or equal to 10 mg bupivacaine plus fentanyl 15 mcg is effective in providing rapid anesthesia and analgesia with significantly less hypotension

and vasopressor requirements.