Epidural anesthesia for cesarean section with 0.125% versus 0.25% bupivacaine: An Ecuadorian prospective cohort.

ANTECEDENTES: En una cesárea se puede emplear analgesia epidural con bupivacaína 0.125% and lidocaína 1.5% ó bupivacaína 0.25% and lidocaína 1.0%. Una concentración mayor de bupivacaína alcanza mayor analgesia con más eventos adversos.

OBJETIVO: evaluar la analgesia y seguridad de bupivacaína 0.125% and lidocaína 1.5% ó bupivacaína 0.25% and lidocaína 1.0%.

MATERIALES Y MÉTODOS: Cohorte prospectivo estratificado según ambas concentraciones de bupivacaína.

RESULTADOS: Se recuperó cien gestantes a término (cincuenta por cohorte). A los 20 y 30 minutos tras la administración epidural hubo más casos con mayor bloqueo motor en quienes se empleó bupivacaína 0.125% and lidocaína 1.5% (p = 0.0229 y p = 0.0006, respectivamente). No hubo diferencia significativa respecto al bloqueo sensitivo. Bupivacaína 0.25% and lidocaína 1.5% mostró una tencencia a la hipotensión (p < 0.001) y a la bradicardia (p = 0.4100). De la cohorte de bupivacaína 0.125% and lidocaína 1.5%, 25 casos (50%) presentaron cuando menos un evento adverso, en contraste con 44/50 (88%) de la cohorte de bupivacaína 0.25% and lidocaína 1.0% (p < 0.001).

CONCLUSIÓN: En la analgesia epidural durante cesárea, bupivacaína 0.125% and lidocaína 1.5% está asociado con un efecto analgésico similar a bupivacaína 0.25% and lidocaína 1.0%. Sin embargo, mayores concentraciones están significativamente relacionadas con mayor tasa de eventos adversos (especialmente hipotensión).

BACKGROUND: In a cesarean section, epidural analgesia with 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine concentrations can be used. A higher concentration of bupivacaine reaches better analgesia but with a higher rate of drug-related adverse events.

AIM: The aim of the study was to assess analgesia and safety of 0.125% bupivacaine and 1.5% lidocaine or 0.25% bupivacaine with 1.0% lidocaine during cesarean.

MATERIALS AND METHODS: Prospective cohort stratified following both bupivacaine concentrations.

RESULTS: One hundred women with full-term pregnancies were selected (fifty per cohort). At 20 and 30 min after epidural administration, there was a higher proportion of motor blockade cases from the 0.125% bupivacaine and 1.5% lidocaine cohort (p = 0.0229 and p = 0.0006, respectively). There was no significant difference among sensitive blockage. A 0.25% bupivacaine and 1.0% lidocaine concentration showed a tendency to hypotension (p < 0.001) and bradycardia (p = 0.4100). From 0.125% bupivacaine and 1.5% lidocaine cohort, 25 cases (50%) presented at least one adverse event; in contrast with 44/50 (88%) from 0.25% bupivacaine and 1.0% lidocaine cohort (p < 0.001).

CONCLUSION: In epidural analgesia during cesarean, using 0.125% bupivacaine and 1.5% lidocaine presented similar analgesia than 0.25% bupivacaine and 1.0% lidocaine. However, a higher bupivacaine concentration is significantly related to more frequent drug-related adverse events (especially hypotension).