THE EFFECT OF HEIGHT AND WEIGHT ADJUSTED SUBARACHNOID DOSE OF BUPIVACAINE ON INCIDENCE OF COMPLICATIONS FOLLOWING SPINAL ANAESTHESIA FOR CAESAREAN SECTION
Dr. Ozoagu A. M.*, Isamade E. S., Akpa F. N. and Efu M. E.
ABSTRACT
Background: Caesarean section is one of the most commonly performed surgical operations in obstetric practice dating back to 100BC. The caesarean section rate varies around the world from 5% and up to 75%. It is about 15 to 21% in most West African countries. However, in some Teaching Hospitals in Nigeria, the average is about 18%- 27.6%.The use of spinal anaesthesia dates back to 1885. The very first spinal anaesthesia was performed by J. Leonard Corning, a neurologist in New York, USA, using cocaine in 1885. Spinal anaesthesia offers a fast, profound and high quality sensory and motor block in women undergoing caesarean section. The most common complication of spinal anaesthesia for caesarean section is hypotension with a reported incidence of 65% to 80%. The present study compared the adequacy of anaesthesia and the height of block using fixed dose of bupivacaine and an adjusted dose. The rate of complications in both groups was also compared. Methodology: This was a prospective, randomized, double-blind study carried out in National Hospital, Abuja over six months period. 140 patients undergoing CS were randomized to receive Bupivacaine in either a fixed dose or dose adjusted to height- weight. The results were analyzed with both descriptive and inferential statistics. Results: Significant differences were noted between the two groups. Compared to the height-weight adjusted dose group, patients in the fixed dose group had lower intra-operative mean arterial pressure (p=0.001), higher incidence of hypotension (62.9% vs 28.6% with p<0.001), and so needed more ephedrine (62.9% vs 28.6%), and more patients reported nausea (15.7 % vs 2.9% at p=0.009) but there was no vomiting in either group. Shivering occurred in 24.3% in the fixed dose group compared to 8.6% of patients in the adjusted dose group (p=0.012). One patient in the fixed dose group reported peritoneal discomfort compared to five cases reported in the adjusted dose group (p=0.096). Conclusion: Adjusting the dose of hyperbaric bupivacaine to patients' height and weight for elective caesarean section not only provide adequate analgesia for elective caesarean section, but is also associated with reduced risk of hypotension, shivering and nausea. However, there is a higher risk of peritoneal discomfort. Thus, dose adjustment, where possible, is hereby recommended.
Keywords: Height, weight, adjusted dose, bupivacaine, complication, spinal anaesthesia, caesarian section.
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