Hyperbaric Prilocaine 2% vs Hyperbaric Bupivacaine 0.5% in Caesarean Section

A Comparative Study Between Hyperbaric Prilocaine 2% Versus Hyperbaric Bupivacaine 0.5% For Intrathecal Anesthesia in Caesarean Section

Comparison between effects of hyperbaric bupivacaine 0.5% vs Hyperbaric prilocaine 2% in spinal anesthesia of women undergoing elective caesarean section such as onset time of sensory and motor block, duration of sensory and motor block, effects of maternal hemodynamics and expected side effects .

Study Overview

• Status: Completed
• Conditions: Spinal Anesthesia
• Intervention / Treatment: Drug: spinal anesthesia (hyperbaric Prilocaine 2%); Drug: Spinal anesthesia (heavy bupivacaine 0.5%)

Detailed Description

Patients will be randomly allocated into two groups:

1. Prilocaine Group (Group A):

   • Patients will receive 60 mg of hyperbaric prilocaine 2% intrathecally.
   • The anesthetic solution will be injected intrathecally using a 25 Gauge spinal needle, with the patient in a sitting position (midline or paramedian technique).
   • The injection will be performed at the L3-L4 or L4-L5 interspace.

2. Bupivacaine Group (Group B):

   • Patients will receive 12.5 mg of hyperbaric bupivacaine 0.5% intrathecally.
   • The anesthetic solution will be injected intrathecally using a 25 Gauge spinal needle, with the patient in a sitting position (midline or paramedian technique) .
   • The injection will be performed at the L3-L4 or L4-L5 interspace.

Procedure Details:

Prior to the procedure, patients will be preloaded with 500 ml of balanced crystalloid solution intravenously. Patients will be positioned in the sitting position for the spinal injection.

The chosen interspace (L3-L4 or L4-L5) will be identified, and the skin will be prepared with an antiseptic solution. A 25 Gauge spinal needle will be used for the intrathecal injection (midline or paramedian technique). After confirming free flow of cerebrospinal fluid, the prepared anesthetic solution will be injected over 10-15 seconds. Following the injection, patients will be placed supine with a slight left lateral tilt to avoid aortocaval compression. The sensory block level will be assessed using Pinprick sensation test, and the motor block will be evaluated using the modified Bromage scale. 5 Blood pressure and heart rate will be monitored every 5 mins until the end of the surgery. In case of hypotension (systolic BP < 90 mmHg or diastolic BP < 60 mmHg), intravenous boluses of 10 mg ephedrine will be administered until blood pressure stabilizes. In case of Bradycardia with Heart rate <55 bpm atropine sulphate 0.01 mg/kg will be given intravenous. Pain Assessment will be done postoperatively via Visual analogue score (VAS) as following if score 3 or less no analgesia required if score 4-5, 1g paracetamol iv will be given if score 6-7, 30mg ketorolac iv will be given if score 7 or more, 2.5mg morphine sulphate iv will be given

• Study Type: Interventional
• Enrollment (Actual): 142
• Phase: Early Phase 1

Contacts and Locations

Study Locations

• Egypt
  • Sohag Governorate
    • Sohag, Sohag Governorate, Egypt, 82749
      • Sohag University hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Women aged 18-45 years.
2. Patients with uncomplicated pregnancies.
3. American society of anesthesiologist (ASA) physical status I or II.
4. Height between 155 cm and 175 cm.
5. Written informed consent provided. -

Exclusion Criteria:

1. Patients with known allergies to local anesthetics.
2. Contraindications to intrathecal anesthesia (e.g., infection at the injection site and coagulopathy).
3. Severe preeclampsia or eclampsia.
4. Presence of significant comorbidities (e.g., uncontrolled diabetes, hypertension, renal or hepatic dysfunction).
5. History of spinal surgery or significant spinal deformity.
6. Patients who refuse to participate in the study -

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: patients of group A will receive 60mg of hyperbaric prilocaine 2% for spinal anesthesia	Drug: spinal anesthesia (hyperbaric Prilocaine 2%); 60mg of Hyperbaric Prilocaine 2% will be injected intrathecally for women undergoing elective caesarean section
Active Comparator: patients of group B will receive 12.5mg heavy bupivacaine for spinal anesthesia	Drug: Spinal anesthesia (heavy bupivacaine 0.5%); 12.5mg of Heavy bupivacaine 0.5% will be injected intrathecally for women undergoing elective caesarean section

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Measurment of onset time and duration of sensory block of Hyperbaric Bupivacaine 0.5% and Hyperbaric Prilocaine 2% using pinprick sensation test in women undergoing caesarean section	12 HOURS
2- Measurment of onset time and duration of motor block of Hyperbaric Bupivacaine 0.5% and Hyperbaric Prilocaine 2% using modified bromage scale in women undergoing caesarean section	12 hours

Collaborators and Investigators

• Sponsor: Sohag University

Study record dates

Study Major Dates

• Study Start (Actual): October 9, 2024
• Primary Completion (Actual): November 5, 2025
• Study Completion (Actual): December 24, 2025

Study Registration Dates

• First Submitted: November 5, 2024
• First Submitted That Met QC Criteria: November 6, 2024
• First Posted (Actual): November 8, 2024

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: onset time and duration of action; effects on maternal hemodynamics intraoperative and postoperative; evaluation of pain scores postoperatively
• Additional Relevant MeSH Terms: Anesthesia and Analgesia; Anesthesia, Conduction; Anesthesia; Anesthesia, Spinal
• Other Study ID Numbers: Soh-Med-15-10---6MS

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: for risk of participant data identification and for privacy concerns

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No