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Low-Dose Bupivacaine-Fentanyl Spinal Anesthesia for Cesarean Delivery
  1. Bruce Ben-David, M.D.,
  2. Gabriella Miller, M.D.,
  3. Rahel Gavriel, M.D. and
  4. Alexander Gurevitch, M.D.
  1. From the Department of Anesthesia, Allegheny General Hospital (B.B.-D.), Pittsburgh, Pennsylvania; and the Department of Anesthesia, Western Galilee Hospital (G.M., R.G., A.G.), Nahariya, Israel.
  1. Reprint requests: Bruce Ben-David, M.D., Department of Anesthesia, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212. E-mail: bbendavid{at}


Background and Objectives The hypotension following spinal anesthesia remains commonplace in cesarean delivery. Intrathecal opioids are synergistic with local anesthetics and intensify sensory block without increasing sympathetic block. The combination makes it possible to achieve spinal anesthesia with otherwise inadequate doses of local anesthetic. We hypothesized that this phenomenon could be used to provide spinal anesthesia for cesarean delivery while incurring less frequent hypotension.

Methods Thirty-two women scheduled for cesarean delivery were divided into 2 groups of patients who received a spinal injection of either 10 mg of isobaric (plain) bupivacaine 0.5% or 5 mg of isobaric bupivacaine with 25 μg fentanyl added. Each measurement of a systolic blood pressure less than 95 mm Hg or a decrease in systolic pressure of greater than 25% from baseline was considered as hypotension and treated with a bolus of 5 to 10 mg of intravenous ephedrine.

Results Spinal block provided surgical anesthesia in all patients. Peak sensory level was higher (T3 v T4.5) and motor block more intense in the plain bupivacaine group. The plain bupivacaine patients were more likely to require treatment for hypotension (94% v 31%) and had more persistent hypotension (4.8 v 0.6 hypotensive measurements per patient) than patients in the minidose bupivacaine-fentanyl group. Mean ephedrine requirements were 23.8 mg and 2.8 mg, respectively, for the 2 groups. Patients in the plain bupivacaine group also complained of nausea more frequently than patients in the minidose bupivacaine-fentanyl group (69% v 31%).

Conclusions Bupivacaine 5 mg + fentanyl 25 μg provided spinal anesthesia for cesarean delivery with less hypotension, vasopressor requirements, and nausea than spinal anesthesia with 10 mg bupivacaine.

  • Cesarean delivery
  • Obstetric anesthesia
  • Regional anesthesia
  • Spinal anesthesia

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  • The work for this study was conducted in Western Galilee Hospital, Nahariya, Israel.