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Fractionated Dose Vs Conventional Method of Drug Administration in Spinal Anesthesia for Pregnant Women Undergoing Cesarean Section: A Comparative Study

Manjula V Ramsali , Vanagondi Siva Kumar , Manjula V Ramsali , Vankayapati Sarada Devi , Kulkarni Dilip Kumar , Pasupuleti Surender

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Indian Journal of Anesthesia and Analgesia 6(6):p 2206-2211, November-December 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6619.52

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Vanagondi Siva Kumar, Manjula V Ramsali, Vankayapati Sarada Devi et al. Fractionated Dose Vsconventional Method of Drug Administration in Spinal Anesthesia for Pregnant Women Undergoing Cesarean Section: A Comparative Study. Indian J Anesth Analg. 2019;6(6 Part - II):2206-2211.

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Abstract

Background: Spinal Anesthesia (SA) is the routine and safe method of administering anesthesia for performing Elective or emergency cesarean sections. SA with conventional (bolus dose) method of injection provides rapid onset of action with high spinal blockade leading to hypotension, compromised the uteroplacental circulation and fetal acid-base imbalance. Our study aimed to compare, low dose bupivacaine injection by conventional to fractionated method to achieve the desired level of anesthesia with stable hemodynamic in SA. Onset of sensory and motor blockade, and duration of analgesia were monitored in patients undergoing elective Lower Segment Cesarean Section (LSCS). Methods: Sixty pregnant women undergoing elective Lower Segment Cesarean Section (LSCS) were included in the study and they were randomly allocated into two Groups. Group C patients received bolus dose of bupivacaine (0.5%) heavy by conventional method and Group F received the same dose of Bupivacaine in fractionated manner with two third of it initially followed by remaining one third dose after 30 secs. The hemodynamic monitoring consisted of Mean Arterial Pressure (MAP), Heart Rate (HR). Other variables recorded were time of onset, duration of analgesia, and regression of sensory and motor blockade. The vasopressor required as rescue drug for hypotension when fall of MAP below 20% of the basal value were observed and noted. Results: The hemodynamics were statistically comparable in both the Groups. The onset of sensory block was slightly delayed (2.50 ± 0.68 vs 3.47 ± 1.53), duration of analgesia was prolonged (141.10 ± 24.32 vs 166.80 ± 52.11) and the vasopressor requirement was less (5.33 ± 3.93 vs 2.20 ± 4.02) in Group F as compared to Group C and these results were statistically significant. The Apgar scores between the two Groups (p > 0.05) were not significant. Conclusion: SA in pregnant women for LSCS by fractionated technique of drug injection provided slightly slower onset of only sensory blockade with prolonged duration of analgesia. The statistically significant less vasopressor requirement in the study group was observed as compared to the conventional group which in turn concludes the hemodynamics more stable in the study group.

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Vanagondi Siva Kumar, Manjula V Ramsali, Vankayapati Sarada Devi et al. Fractionated Dose Vsconventional Method of Drug Administration in Spinal Anesthesia for Pregnant Women Undergoing Cesarean Section: A Comparative Study. Indian J Anesth Analg. 2019;6(6 Part - II):2206-2211.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6619.52

Keywords

LSCS; Fractionation; Conventional bolus dose; SA block; Hemodynamics.

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