Obstetric spinal analgesia and anesthesia

Current Opinion in Anaesthesiology

Volumn 16, Issue 5, 2003, Pages 503-507

  Vercauteren, Marcel ^a  

^a ANTWERP UNIVERSITY HOSPITAL   (Belgium)

Author keywords

Anesthesia; Cesarean; Obstetrics; Spinal

Indexed keywords

ACETYLSALICYLIC ACID; ADENOSINE; ADRENALIN; ANALGESIC AGENT; ANESTHETIC AGENT; BUPIVACAINE; DIAMORPHINE; EPHEDRINE; FENTANYL; LEVOBUPIVACAINE; LOCAL ANESTHETIC AGENT; MAGNESIUM; MORPHINE; NEOSTIGMINE; OPIATE AGONIST; PETHIDINE; PHENYLEPHRINE; ROPIVACAINE; SUFENTANIL;

ANALGESIA; BACKACHE; CESAREAN SECTION; DRUG DOSE REDUCTION; DRUG EFFECT; DRUG POTENCY; DRUG SAFETY; EPIDURAL ANESTHESIA; EVIDENCE BASED MEDICINE; HEART DISEASE; HUMAN; HYPOTENSION; HYPOVOLEMIA; LABOR PAIN; LOW DRUG DOSE; LUNG EDEMA; MICTURITION DISORDER; NAUSEA; OBSTETRIC ANESTHESIA; PATIENT SATISFACTION; PHARMACOLOGICAL BLOCKING; POSTOPERATIVE PERIOD; PREECLAMPSIA; PRIORITY JOURNAL; REGIONAL ANESTHESIA; REVIEW; SPINAL ANESTHESIA; TREATMENT OUTCOME; VOMITING;

EID: 0142061615     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-200310000-00010     Document Type: Review

References (52)

1. Khaw KS, Ngan Kee WD, Wong EL, et al. Spinal ropivacaine for Cesarean section. Anesthesiology 2001; 95:1346-1350.
2. Khaw KS, Ngan Kee WD, Wong M, et al. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions. Anesth Analg 2002; 94:680-685.
3. Khaw KS, Ngan Kee WD. High failure rate of small doses of ropivacaine when used alone for spinal anesthesia for cesarean delivery. Reg Anesth Pain Med 2002; 27:534-535.
4. Ogun CO, Kirgiz EN, Duman A, et al. Comparison of intrathecal isobaric bupivacaine-morphine and ropivacaine-morphine for Caesarean delivery. Br J Anaesth 2003; 90:659-664. The addition of morphine to isobaric ropivacaine 15 mg offers excellent spinal anesthesia for Cesarean section, but motor block will not last as long as with a similar dose of bupivacaine.
5. Chung CJ, Yun SH, Hwang GB, et al. Intrathecal fentanyl added to hyperbaric ropivacaine for cesarean delivery. Reg Anesth Pain Med 2002; 27:600-603. Adding fentanyl 10 μg to hyperbaric ropivacaine 18 mg improves intraoperative analgesia, prolongs the duration of the sensory block and provides effective analgesia in the postoperative period.
6. Lacassie HJ, Columb MO, Lacassie HP, Lantadilla RA. The relative motor blocking potencies of epidural bupivacaine and ropivacaine in labor. Anesth Analg 2002; 95:204-208. Using the MLAC design in 60 parturients, the authors demonstrated that ropivacaine was less potent as a motor block, at 66% that of bupivacaine. This means that this ratio is similar to the sensory potency ratio between these two local anesthetics.
7. Vercauteren MP, Hans G, De Decker K, Adriaensen HA. Levobupivacaine combined with sufentanil and epinephrine for intrathecal labor analgesia: a comparison with racemic bupivacaine. Anesth Analg 2001; 93:996-1000.
8. Whiteside JB, Burke D, Wildsmith JA. Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003; 90:304-308
9. Panni M, Segal S. New local anesthetics: are they worth the cost? Anesthesiol Clin North Am 2003; 21:19-38. Based upon the available data in the literature, the authors conclude that the new local anesthetics despite their lower toxicity have little to offer when they are used in diluted concentrations or spinal techniques. Considering the potency issue, even the advantage in terms of motor impairment becomes less important for ropivacaine. Overall, the higher costs related to the use of the newer local anesthetics do not justify replacing bupivacaine.
10. Meininger D, Byhahn C, Kessler P, et al. Intrathecal fentanyl, sufentanil or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective Cesarean section. Anesth Analg 2003; 96:852-858.
11. Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intrathecal fentanyl and diamorphine in addition to bupivacaine for Cesarean section under spinal anaesthesia. Br J Anaesth 2002; 89:452-458. Both opioids offer intraoperative benefit when added to intrathecal bupivacaine, but diamorphine is superior as it provides longer lasting analgesia in the postoperative period.
12. Nelson KE, Rauch T, Terebuh V, D'Angelo R. A comparison of intrathecal fentanyl and sufentanil for labor analgesia. Anesthesiology 2002; 96:1070-1073. The authors have determined the ED50 values for 60 min of labor analgesia and found that the relative potency ratio of intrathecal sufentanil to fentanyl is 4.4:1. In addition, when administering two times the ED50 dose, the duration of analgesia obtained with sufentanil was 25 min longer.
13. Siddik-Sayyid SM, Aouad MT, Jalbout MI, et al. Intrathecal versus intravenous fentanyl for supplementation of subarachnoid block during cesarean delivery. Anesth Analg 2002; 95:209-213. Intrathecal fentanyl offers better analgesia with less hypotension, nausea and vomiting than intravenous fentanyl to supplement 12 mg of hyperbaric bupivacaine.
14. Sarvela J, Halonen P, Soikkeli A, Korttila K. A double-blinded, randomized comparison of intrathecal and epidural morphine for elective cesarean delivery. Anesth Analg 2002; 96:436-440. In this randomized study of 150 parturients, intrathecal administration of 100 μg morphine was superior to 200 μg or 3 mg given epidurally, mainly due to the reduced incidence of pruritus.
15. Yu SC, Ngan Kee WD, Kwan AS. Addition of meperidine to bupivacaine for spinal anaesthesia for Caesarean section. Br J Anaesth 2002; 88:379-383.
16. Paech MJ, Banks SL, Gurrin LC, et al. A randomized, double-blinded trial of subarachnoid bupivacaine and fentanyl, with or without clonidine for combined spinal/epidural analgesia during labor. Anesth Analg 2002; 95:1396-1401. In this excellent study 110 parturients received bupivacaine 2.5 mg plus fentanyl 20 μg plus either saline, clonidine 15, 30 or 45 μg. Clonidine, regardless of the dose used, did not prolong intrathecal labor analgesia but it caused a dose-dependent hypotension and ephedrine requirement. As opposed to previous studies these authors conclude that the addition of clonidine in intrathecal labor analgesia does not make good practice.
17. Roelants F, Rizzo M, Lavand'homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg 2003; 96:1161-1166. Although this is an epidural study, the authors confirmed the findings of previous intrathecal studies that neostigmine does not offer better or longer lasting analgesia, but in a dose of 4 μg/kg it does not cause untoward effects.
18. Owen MD, Ozsarac O, Sahin S, et al. Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacaine-fentanyl for labor analgesia. Anesthesiology 2000; 92:361-366.
19. D'Angelo R, Dean LS, Meister GC, Nelson KE. Neostigmine combined with bupivacaine, clonidine, and sufentanil for spinal labor analgesia. Anesth Analg 2001; 93:1560-1564.
20. Goodman SR, Kim-Lo SH, Ciliberto CF, et al. Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia. Reg Anesth Pain Med 2002; 27:374-379. The addition of 100 μg epinephrine to bupivacaine 2.5 mg and fentanyl 35 μg as part of a CSE-technique for labor analgesia does not prolong the duration of analgesia; on the contrary, it causes increased nausea while motor block induced by bupivacaine is also more pronounced.
21. Okutomi T, Mochizuki J, Amano K, Datta S. The effect of intrathecal epinephrine on epidural infused analgesics during labor. Reg Anesth Pain Med 2003; 28:108-112. This study also used 100 μg of epinsphrine but in contradistinction to the previous study of Goodman et al. [20•], these authors found that this dose of intrathecally injected epinephrine resulted in less epidural bupivacaine requirement. The authors also found more motor block in the epinephrine treated patients.
22. Buvanendran A, McCarthy RJ, Kroin JS, et al. Intrathecal magnesium prolongs fentanyl analgesia: a prospective, randomized, controlled trial. Anesth Analg 2002; 95:661-666.
23. Rane K, Sollevi A, Segerdahl M. A randomised double-blind evaluation of adenosine as adjunct to sufentanil in spinal labour analgesia. Acta Anaesthesiol Scand 2003; 47:601-603.
24. Wilson MJ for the Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Randomized controlled trial comparing traditional with two mobile epidural techniques: anesthetic and analgesic efficacy. Anesthesiology 2002; 97:1567-1575. This is an excellent study in 1054 parturients receiving traditional epidural analgesia with bupivacaine 0.25%, a low dose infusion utilizing 0.1% bupivacaine with fentanyl 2 μg/ml or an intrathecal injection of bupivacaine 2.5 mg plus fentanyl 25 μg followed by epidural top-ups of 15 ml of the mixture as used for low-dose infusion. The CSE technique resulted in faster onset of analgesia, better analgesia during the first hour and less total bupivacaine requirements. The traditional epidural group required less anesthesiologist reattendance than the other two 'mobile' groups.
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30. Comparative Obstetric Mobile Epidural Trial (COMET) Study group UK. Effect of low-dose mobile versus traditional techniques on mode of delivery. Lancet 2001; 358:19-23.
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32. Vercauteren MP, Coppejans HC, Hoffmann VH, et al. Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. Anesth Analg 2000; 90:324-327.
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34. Kee WD, Khaw KS, Lee BB, et al. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2000; 90:1390-1395.
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38. Ngan Kee WD, Khaw KS, Lee BB, et al. Metaraminol infusion for maintenance of arterial blood pressure during spinal anesthesia for cesarean delivery: the effect of a crystalloid bolus. Anesth Analg 2001; 93:703-708.
39. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002; 94:920-926. Based upon seven randomized controlled trials (n = 292) this review found that women given ephedrine had lower umbilical cord blood pH values in comparison with those receiving phenylephrine despite identical Apgar scores and incidences of fetal acidosis. This is not surprising because all individual studies found results favoring the use of phenylephrine.
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