Application of low dose bupivacaine combined with fentanyl plus spinal-epidural anesthesia in emergency cesarean section

Objective To evaluate the feasibility of low dose bupivacaine combined with fentanyl plus spinal-epidural anesthesia in emergency cesarean section.Methods One hundred and eight parturients with singleton fetus for emergency cesarean section were divided randomly into two groups,bupivacaine with fentanyl group(group BF) and bupivacaine group(group B).Group BF received 0.75% bupivacaine 5 mg and fentanyl 20 μg,while group B received 0.75% bupivacaine 7.5 mg.All the parturients received the a puncture at L2-3 intervertebral space with CESA needles at right lateral position,then epidural catheter was reserved.The following were recorded,onset time,highest sensory level,adding epidural drugs,changes of intra-operative blood pressure and heart rate,the use of ephedrine,complications such as nausea,vomiting,dyspnea and other side effects.The evaluation from surgeons,patients of anesthesia effects and the time for complete recovery of lower limb muscle strength were also recorded.Results All patients successfully completed the operations without changing anesthesia method or using adjuvant intravenous drugs.Compared with those of group B,group BF had fewer cases in adding epidural anesthetics,hypotension and requiring ephedrine(P0.01).The average dose of ephedrine was lower(P0.05),the incidence of nausea and vomiting were low in group BF(P0.05),and occurrence of dyspnea was also lower in group BF(P0.01).Time for the lower limb muscle strength return to Bromage 0 score was shorter in group BF(P0.05).Conclusion It provides satisfactory anesthesia for emergency cesarean section that using 0.75 % bupivacaine 5 mg plus fentanyl 20 μg in combined spinal-epidural anesthesia.