A Comparative Study of Fractionated Versus Single Dose Injection for Spinal Anesthesia During Cesarean Section in Patients with Pregnancy-Induced Hypertension

Alfan Mahdi Nugroho, Adhrie Sugiarto, Susilo Chandra, Laras Lembahmanah, Rafidya Indah Septica, Annisaa Yuneva, Alfan Mahdi Nugroho, Adhrie Sugiarto, Susilo Chandra, Laras Lembahmanah, Rafidya Indah Septica, Annisaa Yuneva

Abstract

Background: Local anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being.

Objectives: This study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section.

Methods: This single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18 - 40 years, and BMI of 18.5 - 35 kg/m2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (MarcaineTM, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD).

Results: There was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0 - 25) mg in the FD group vs. 15 (0 - 30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59).

Conclusions: In obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.

Keywords: Bupivacaine; Cesarean Section; Hypotension; Pregnancy-Induced Hypertension; Spinal Anesthesia.

Figures

Figure 1.. Study flow according to the…
Figure 1.. Study flow according to the consolidated standards of reporting trials (CONSORT) diagram
Figure 2.. Mean arterial pressure (MAP) trend
Figure 2.. Mean arterial pressure (MAP) trend

References

    1. Tsen LC. Anesthesia for caesarean delivery. In: Chestnut D, Wong C, Tsen L, Ngan-Kee W, Beilin Y, Mhyre J, editors. Chestnut's obstetric anesthesia: Principles and practice. 5th ed. Philadelphia: Elseviers Saunders; 2014.
    1. Khaw KS, Kee WDN, Lee SW. Hypotension during spinal anaesthesia for caesarean section: Implications, detection prevention and treatment. Fetal Maternal Med Rev. 2006;17(02):157. doi: 10.1017/s0965539506001756.
    1. Kurnia A. Faktor prognostik kejadian hipotensi pada Ibu Hamil yang menjalani operasi sesar dengan anestesia spinal [dissertation]. Jakarta: Universitas Indonesia; 2016.
    1. Chumpathong S, Chinachoti T, Visalyaputra S, Himmunngan T. Incidence and risk factors of hypotension during spinal anesthesia for cesarean section at Siriraj Hospital. J Med Assoc Thai. 2006;89(8):1127–32.
    1. Sharwood-Smith G, Drummond GB. Hypotension in obstetric spinal anaesthesia: A lesson from pre-eclampsia. Br J Anaesth. 2009;102(3):291–4. doi: 10.1093/bja/aep003.
    1. Redman CW, Sargent IL. Pre-eclampsia, the placenta and the maternal systemic inflammatory response: A review. Placenta. 2003;24 Suppl A:S21–7.
    1. Bateman B, Polley L. Hypertensive disorders. In: Chestnut D, Wong C, Tsen LC, Ngan-Kee W, Beilin Y, Mhyre J, editors. Chestnut's obstetric anesthesia: Principles and practice. 5th ed. Philadelphia: Elseviers Saunders; 2014. pp. 825–52.
    1. Badheka JP, Oza VP, Vyas A, Baria D, Nehra P, Babu T. Comparison of fractionated dose versus bolus dose injection in spinal anaesthesia for patients undergoing elective caesarean section: A randomised, double-blind study. Indian J Anaesth. 2017;61(1):55–60. doi: 10.4103/0019-5049.198390.
    1. George EM, Granger JP. Recent insights into the pathophysiology of preeclampsia. Expert Rev Obstet Gynecol. 2010;5(5):557–66. doi: 10.1586/eog.10.45.
    1. Ramanathan J, Bennett K. Pre-eclampsia: Fluids, drugs, and anesthetic management. Anesthesiol Clin North America. 2003;21(1):145–63.
    1. Ramanathan J, Gill RS, Sibai B. Hypertensive disorders of pregnancy. In: Suresh M, editor. Shnider and levinson's anesthesia for obstetrics. 5th ed. Philadelphia: Wolters Kluwer Health; 2013.
    1. Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 2004;92(4):469–74. doi: 10.1093/bja/aeh088.
    1. Posangi I. Keefektifan anestesia spinal menggunakan bupivakain 0.5% hiperbarik 6 mg ditambah fentanyl 25 mcg dibandingkan dengan bupivakain 0.5% hiperbarik 7.5 mg pada bedah caesar [dissertation]. Jakarta: Universitas Indonesia; 2011.
    1. Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568–78. doi: 10.1093/bja/aeh204.
    1. Maheshwari K, Naguib MA. Local anesthetics. In: Flood P, Rathmell JP, Shafer S, editors. Pharmacology and physiology in anesthetic practice. 5th ed. Philadelphia: Wolters Kluwer; 2015. pp. 180–209.

Source: PubMed

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