Choice of either anaesthesia technique for caesarean section

Abstract

Aim: To compare the hemodynamics and duration of analgesia using fractionated / bolus dose of bupivacaine with fentanyl for spinal anaesthesia (SA) in patients undergoing elective caesarean section (CS). Method: Comparative, interventional randomized study in tertiary care hospital in Delhi, India for a period of 12 months (1st January 2019 till 31st December 2019). 204 female antenatal patients of Indian origin between age 18 to 40 years were studied. Bolus group (Group B) patients received intrathecal injection of 0.5% hyperbaric bupivacaine with fentanyl (10mcg) as single bolus dose. Fractionated group (group F) patients received intrathecal injection of 0.5% hyperbaric bupivacaine with fentanyl (10 mcg) with an initial bolus equal to two-third of the calculated volume and remaining volume injected after 90 seconds. Both groups received doses according to Harten’s chart. The groups were compared in terms of maternal hemodynamics, duration of analgesia, sensory and motor block level. Results: Group F patients were noted to have a better haemodynamic profile, both in terms of blood pressure (p<0.001) and heart rate, though not statistically significant (p=0.08). Time taken to reach sensory level T5 was higher in group F, while time taken for motor block was lower in group F (p<0.05). Time for providing rescue analgesia was lower in group B making duration of analgesia lower in bolus group (p<0.05). Conclusions: Fractionated dose of local anaesthesia in subarachnoid block can give better hemodynamic stability, produce quicker onset and later regression of both sensory and motor block along with prolonged duration of analgesia. Trial Registration: CTRI No. CTRI/2019/07/020121.