There is limited evidence supporting superiority between plain or hyperbaric spinal bupivacaine for spinal cesarean section.

pearl

• Heng SiaAlex TiongATFrom the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics and Gynaecology, and Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore; and Clinical Research Institute, Singapore, , Kok Hian Tan, Ban Leong Sng, Yvonne Lim, ChanEdwin S YESY, and Fahad Javaid Siddiqui.
• From the Duke-NUS Graduate Medical School, Singapore, Singapore; Medical Board, Obstetrics and Gynaecology, and Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore; and Clinical Research Institute, Singapore, Singapore.
• Anesth. Analg. 2015 Jan 1; 120 (1): 132-140.

BackgroundBupivacaine is an amide local anesthetic used in hyperbaric and plain forms administered as spinal anesthesia for cesarean delivery. In this systematic review, we summarized the effectiveness and safety of hyperbaric versus plain bupivacaine in providing anesthesia for cesarean delivery. We considered the adequacy of anesthesia for completion of cesarean delivery and the need for interventions to treat complications.MethodsWe searched the CENTRAL, MEDLINE, and EMBASE databases. We imposed no language restriction. We included all randomized controlled trials involving patients undergoing spinal anesthesia for elective cesarean delivery that compared the use of hyperbaric bupivacaine with plain bupivacaine.ResultsWe included 6 studies with a total of 394 patients in this review. These studies have small sample size, few observed events, differences in methodology, and insufficient information pertaining to assessment of risk of bias. This prevented us from calculating pooled estimates. Results show that there is no compelling evidence in favor of the use of intrathecal plain or hyperbaric bupivacaine for spinal anesthesia for cesarean delivery.ConclusionsThere is a lack of clear evidence regarding the superiority of hyperbaric compared with plain bupivacaine for spinal anesthesia for cesarean delivery. The need for conversion to general anesthesia because of failed spinal anesthesia is an important clinical outcome, but current data are insufficient to compare spinal anesthesia induced with hyperbaric compared with plain bupivacaine for this outcome. Further research is required.

This article appears in the collections: Interesting obstetric spinal anesthesia articles and Neuraxial .

17 keywords...

hide…