Comparison Between Fractionated and Single Bolus Dose of Local Anaesthetic (Bupivacaine 0.5% Heavy) in Elective Lower Segment Caeserean Section

Abstract

Context :  Fractionated dose of local anaesthetic in spinal anaesthesia has been compared with single bolus dose in terms of hemodynamic stability. Aims: Comparison of fractionated dose versus  single bolus dose injection of local anaesthetic  in spinal anaesthesia for patients undergoing elective   caesarean section. Go to:Settings and Design: This prospective comparative study was conducted at a tertiary care hospital in central India. Methods and material: 200 healthy female parturients who were scheduled for elective caesarean section were allocated randomly into two groups- one that received fractionated dose and another that received single bolus dose of bupivacaine heavy (0.5%). With patient in sitting position subarachnoid block was established using dose according to height of the patient(0.07mg/cm height of patient). The single bolus group B recieved bupivacaine in single bolus over 10s. In Fractionated dose group F, patients recieved 2/3^rd of the total calculated dose given initially followed by 1/3^rd dose after 90s,both at a rate 0.2ml/s. After injection of initial 2/3^rd dose, the syringe was kept attached to the spinal needle for the remaining 90s, after which remaining one third dose was administered. Data assessed were the number of hypotensive episodes and number of times vasopressors had to be given. Statistical Analysis: The data was collected using Microsoft excel and Statistical Package for Social Sciences (SSPS ver. 21). Results: There was statistically significant difference between the hemodynamic stability for the two groups.Conclusion:  Fractionated dose of local anaesthetic was found to be hemodynamically more stable than single bolus dose.

 Keywords: hypotension,singlebolusdose,fractionated dose, hemodynamic stability.