The 90% effective dose of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal–epidural anesthesia in parturients with super obesity: an up-down sequential allocation study
Authors' conclusion
The estimated ED90 of hyperbaric bupivacaine with fentanyl and morphine in parturients with super obesity undergoing Cesarean delivery under CSE was approximately 11.5 mg.
Study context
- Population
- Parturients with super obesity (BMI ≥ 50 kg·m-2), term singleton vertex pregnancies, elective Cesarean delivery under CSE42 analysed
- Participants
- 45 participants
- Comparison
- Intrathecal 0.75% hyperbaric bupivacaine doses 9.75–12 mg (0.75-mg increments) with fentanyl and morphine
- 9.75 mgn = 1
- 10.5 mgn = 3
- 11.25 mgn = 27
- 12 mgn = 11
- Outcome
- Block success: T6 block to pinprick within ten minutes and no intraoperative analgesic supplementation within 90 min of spinal injection; ED90 by logistic regression
- Follow-up
- 90 min
Methodological detailsbiased-coin up-down sequential allocation, blinded
- Biased-coin up-down sequential allocation
- Blinded
Main finding
As reported in the abstract
Block success
- Effective dose (ED90) of hyperbaric bupivacaine
- 11.56 mg (95% CI 11.16 to 11.99)
Safety
- Parturients with sensory level higher than T2
- 4 (9.5%)
- Symptomatic or requiring GA
- 0
Original publication
The 90% effective dose of intrathecal hyperbaric bupivacaine for Cesarean delivery under combined spinal–epidural anesthesia in parturients with super obesity: an up-down sequential allocation study. Can J Anaesth. Published 4 March 2024. doi:10.
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