AN INVESTIGATION THAT COMPARES THE SPINAL ANAESTHESIA DURING CAESAREAN DELIVERY ADMINISTERED BY HYPERBARIC AND CONVENTIONAL BUPIVACAINE

Abstract

The investigators sought to compare the effects of hyperbaric bupivacaine vs ordinary bupivacaine on patients having caesarean sections via a rigorous double-blind, randomised controlled trial including 98 parturients. In particular, this study looked at the effects of giving these two medications to patients in addition to fentanyl as part of a combined spinal-epidural surgery. It was discovered that a significant procedure may avoid hypotension. This protocol consisted of 5 mg of ephedrine and 1000 mL of intravenous lactated Ringer's solution. A P-value of less than 0.01 indicates the importance of this observation. Oddly, more patients in the simple bupivacaine group had blocks that were either too high or too low, despite the fact that the attained height of the block in both groups was statistically identical. Additionally, it was shown that both groups had similar numbers of patients in need of epidural supplementation. The researchers used stringent guidelines as a means of addressing potential cases of hypotension in the trial. Put differently, it has been determined that the total incidence of systolic blood pressure falling below 90 mm Hg is 13%. More astonishingly, compared to individuals getting hyperbaric bupivacaine (6%), the incidence was found to be greater in patients receiving conventional bupivacaine (21%). Given that the P-value was less than 0.05, the incidence difference was statistically significant. Additionally, patients in the hyperbaric bupivacaine group received a lower dosage of ephedrine than those in the normal bupivacaine group (a P-value of less than 0.05). This implies that hyperbaric bupivacaine has a greater positive impact on patient outcomes. We also observed that those who received simple bupivacaine reported experiencing nausea more often. These findings so enable us to draw two crucial conclusions. With the inclusion of fentanyl and our preloading technique, intrathecal bupivacaine was the first step towards accomplishing this; hypotension was seen to be significantly reduced. Hyperbaric bupivacaine was shown to be related with a decreased incidence of hypotension and to deliver a more dependable block than ordinary bupivacaine when applied twice. There are more serious clinical ramifications. More precisely, the block spreads more predictably into the brain when fentanyl, which is used for spinal anaesthesia during caesarean sections, is mixed with a tiny volume of bupivacaine 0.5% hyperbaric. This kind of dispersion works far better than glucose-free ones, which are more likely to cause nausea and hypotension. The study's findings will thus help obstetricians, anaesthetists, and other medical professionals make educated judgements regarding the selection and dose of drugs during caesarean sections in order to maximise patient outcomes.