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Indian Journal of Anesthesia and Analgesia

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A Prospective Randomised Double-Blind Comparative Study of Bolus versus Fractionated Dose Injection in Spinal Anaesthesia for Pregnant Women undergoing elective Caesarean Section

Vankaylapatti Sarada Devi, Assistant Professor, Department of Anaesthesia, Malla Reddy Narayana Multi Speciality Hospital and Malla Reddy Medical College For women, Suraram, Jeedimetla, Hyderabad, Telangana 500055, India , Ramasali Manjula V.1 , Vankaylapatti Sarada Devi2 , Appagalla Swathi3 , Kulkarni Dilip Kumar4 , Pasupuleti Surender5

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Indian Journal of Anesthesia and Analgesia 5(11):p 1840-1845, November-December 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51118.11

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Abstract

  Background: Elective or emergency caesarean sections are routinely done under spinal anaesthesia (SA) with bolus dose of local anaesthetic drugs. SA with bolus dose injection provides rapid onset of action but with profound hypotension and can compromise the uteroplacental blood flow which in turn may lead to foetal acid base abnormalities.In our study we hypothesised that by using low dose bupivacaine in fractionated manner to achieve the adequate anaesthesia and stable haemodynamics andcompared with bolus dose of local anaesthetic drug in SA. The following variables were observed: onset of sensory and motor blockade, Mean Arterial Pressure (MAP) Heart Rate (HR), and duration of analgesia in patients undergoing elective lower segment caesareansection (LSCS). Methods: This study was conducted in sixty pregnant women who are undergoing elective lower segment caesarean section (LSCS) after taking permission from the institutional ethical committee. The pregnant women were divided into two groups. Group A patients received single bolus dose of bupivacaine heavy (0.5%) and Group B received the same dose of drug Bupivacaine in fractionated dose with two third of it initially followed by remaining one third dose after 60 secs. The intraoperative haemodynamics (MAP, HR) and duration of analgesia, time of onset and regression of sensory and motor blockade were recorded and analysed with appropriate statistical analysis. Results: The haemodynamics were more stable in group B patients as compared to group A. The requirement of vasopressor was significantly less in group B in contrast to group A (2.40±3.1 vs 5.50±3.79). There was statistically significant (p<0.05) delay in the sensory and motor onset in group B. The duration of analgesia was significantly longer in group B than group A (188.97±18.80 vs 154±22.56).There was no significant difference in the Apgar scores between the two groups (p>0.05). Conclusion: Fractionated dose of local anaesthetic drug in SA provided more haemodynamic stability and longer duration of analgesia compared to the bolus dose of local anaesthetic drug. 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51118.11

Keywords

SA; LSCS; Dose Fractionation; Hypotension; Analgesia.

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