Key result
Fractionated-dose spinal anesthesia shows no difference from single-dose injection in mean arterial pressure or ephedrine use.
Why the study?
Single-injection spinal anesthesia induces more severe hypotension than fractionated dosing in healthy parturients, and hypotension during spinal anesthesia in pregnancy-induced hypertension could compromise fetal well-being.
Does fractionated-dose spinal anesthesia improve mean arterial pressure compared to single-dose injection in obstetric patients with pregnancy-induced hypertension undergoing cesarean section?
RCT (n=42)
Single-blind
Randomly divided
No
Does fractionated-dose spinal anesthesia improve mean arterial pressure compared to single-dose injection in obstetric patients with pregnancy-induced hypertension undergoing cesarean section?
p-value: p=> 0.05
Fractionated-dose spinal anesthesia does not significantly improve mean arterial pressure or reduce ephedrine requirements compared to single-dose injection in patients with pregnancy-induced hypertension undergoing cesarean section.
Fractionated spinal offers no MAP or vasopressor benefit in PIH cesarean delivery; reinforces single-dose as adequate standard.
Background: Local anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being. Objectives: This study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section. Methods: This single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18 - 40 years, and BMI of 18.5 - 35 kg/m2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (MarcaineTM, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD). Results: There was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0 - 25) mg in the FD group vs. 15 (0 - 30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59). Conclusions: In obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.
No takes yet. Share an insight, caveat, or question.
Nugroho et al. (2019) conducted an RCT in Pregnancy-induced hypertension (n=42). Fractionated-dose spinal anesthesia vs. Single-dose spinal anesthesia was evaluated on Mean arterial pressure (MAP) in the first 15 minutes after anesthesia (p=> 0.05). Fractionated-dose spinal anesthesia did not significantly differ from single-dose injection in mean arterial pressure (P > 0.05) or median total ephedrine required (10 mg vs 15 mg; P = 0.30).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: