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Background and Aims ED50 and ED95 values for hyperbaric bupivacaine with opioids for CS in singleton pregnancy were reported as 7.6 mg and 11.2mg. Low-dose sequential combined-spinal epidural anaesthesia (CSEA) is used for adequate anaesthesia and to minimise side effects. The higher spread of spinal anaesthesia was reported in parturients with multiple pregnancies. We present 3cases of triplet pregnancies in which elective C-section(CS) was performed successfully using a low-dose CSEA.

Methods Case 1: A 28-year-old primigravida with a triplet pregnancy underwent elective CS at 34 weeks gestation. The patient received CSE with 5mg of hyperbaric bupivacaine, 25μg of fentanyl, and 100μg intrathecally. An epidural catheter was placed at L3/4. The patient was supinely positioned with left uterine displacement and received colloid fluid as a coload infusion. The sensory block before surgery was T4, and no vasopressor was required until delivery. Oxytocin, methylergometrine, and prostaglandin were administered for atonic bleeding. No additional epidural bolus was necessary during the CS. Case 2: A 33-year-old at 35 weeks, following the same anaesthesia as Case 1. The sensory block was T3, and phenylephrine was administered as needed before delivery. Additional epidural administration was not required during the CS. Case3:A 30-year-old at 35 weeks gestation, the sensory block was T8 with the same anaesthesia as Case 1 and 5ml of 1%-lidocaine was administered to extend the level. The block level achieved T4 before surgery, and phenylephrine was administered as needed. No additional epidural bolus was required.

Conclusions Low-dose sequential CSE provided an appropriate anaesthesia for triplet pregnancies.