Comparison of sensory and motor block outcome of fractionated versus single bolus dose administration of hyperbaric bupivacaine in elective cesarean section
Abstract
Introduction: To achieve the best anesthetic outcome in pregnant women undergoing cesarean deliveries, spinal anaesthesia is the most popularly preferred method. The present study assessed the sensory and motor blockade outcome, following the administration of single bolus dose versus fractionated dose of bupivacaine as spinal anesthesia, in terms of the time of onset and regression, in cesarean section deliveries. Methods: With ethical approval from the corresponding authority and informed written consent from the patients, this study included 100 randomly selected, singleton, non-complicated pregnant women admitted in the Combined Military Hospital (CMH), Dhaka, during the period of July 2018 to June 2019, for elective LUCS. Patients were randomly divided into two equal groups- Group A and Group B, each comprised of 50 patients. Following the standard protocol to administer spinal anesthesia, Group A patients were given a single bolus dose of bupivacaine over 10 seconds and Group B patients were given fractionated dose of bupivacaine with two-third of the total calculated dose given initially, followed by one-third dose after 90 seconds. The age, height and physical status of the patients, the time of onset and regression of sensory and motor block were assessed and recorded. The post-operative pain was assessed with the linear visual analog scale (VAS) every 30 min after surgery for the first 2 hours then hourly up to 6 hours and the duration of analgesia was recorded. All the data has been analyzed with the help of IBM SPSS software (Statistical Package for Social Science) version-22. Results: The mean of the onset of sensory and motor block was faster in Group A than in group B, in case of sensory block onset it was 1.6 ± 0.5 min in Group A and 2.3± 0.8 min in Group B and in case of motor block onset it was 5.4 ± 1.1 min in Group A and 5.9± 1.2 min in Group B (p>0.05). The duration of sensory (Group A: 143.5 ± 23.7, Group B: 212.7 ± 38.6) and motor block (Group A: 118.5 ± 22.5, Group B: 175.2 ± 28.3 was significantly higher in group B than in group A, (p<0.05). Group A patients had a significantly higher mean of the VAS score than Group B patients at each time point (p<0.05). The mean of the duration of analgesia was statistically significantly higher in Group B (235.1± 29.2) than in Group A (198.5±21.3) (p<0.05). Conclusion: This study concludes with the findings that, fractionated administration of bupivacaine in spinal anesthesia provides better aesthetic outcomes in terms of prolonged duration of sensory and motor block.
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References
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