Saudi Journal of Anaesthesia

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 11  |  Issue : 4  |  Page : 421--426

Effect of intravenous phenylephrine infusion on dose requirement of intrathecal plain levobupivacaine for cesarean section: A placebo-controlled preliminary study


Asha Tyagi1, Aanchal Kakkar2, Namrata Niwal3, Medha Mohta1, Ashok Kumar Sethi1 
1 Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
2 Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital; Department of Anaesthesiology and Critical Care, RML Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
3 Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi; Department of Anaesthesiology and Critical Care, Vatsal Hospital, Akola, Maharashtra, India

Correspondence Address:
Asha Tyagi
103, Siddhartha Enclave, Near Ashram Chowk, New Delhi - 110 014
India

Background: Phenylephrine infusion has been shown to decrease rostral spread of plain and hyperbaric local anesthetic (LA) when compared to ephedrine infusion. However, it does not result in higher dose requirement of hyperbaric LA for cesarean section. There is no trial evaluating the effect of phenylephrine infusion on ED50 of a plain intrathecal LA. Methods: Pregnant patients with term uncomplicated singleton pregnancy undergoing elective cesarean section were given combined spinal-epidural anesthesia. They received intrathecal plain levobupivacaine 0.5% in a dose decided by up-and-down sequential allocation method along with 25 μg fentanyl. Intravenous infusion of phenylephrine (100 μg/ml) or normal saline was initiated immediately after intrathecal injection. Systolic arterial pressure ≤0.8 times baseline was treated using rescue boluses of phenylephrine 50 μg. Results: Demographic, other patient and surgical characteristics were similar in the two groups. ED50 of intrathecal plain levobupivacaine was significantly greater in phenylephrine group (5.5 mg [95% confidence interval (CI): 5.1–5.9 mg]) compared to saline group (4.2 mg [95% CI: 3.4–5.1 mg]) (P = 0.01). Maximum sensory level, time to achieve adequate block, Apgar scores, and umbilical artery pH were similar in both groups. Total phenylephrine dose and patients having significant bradycardia were lesser in the saline group. Conclusions: Intrathecal dose requirement of plain levobupivacaine is greater using phenylephrine infusion as compared to saline infusion with rescue phenylephrine boluses. When using phenylephrine as a variable dose regimen titrated to maintain blood pressure within 20% of baseline, the ED50 of plain levobupivacaine is 5.5 mg (95% CI: 5.1–5.9 mg).


How to cite this article:
Tyagi A, Kakkar A, Niwal N, Mohta M, Sethi AK. Effect of intravenous phenylephrine infusion on dose requirement of intrathecal plain levobupivacaine for cesarean section: A placebo-controlled preliminary study.Saudi J Anaesth 2017;11:421-426


How to cite this URL:
Tyagi A, Kakkar A, Niwal N, Mohta M, Sethi AK. Effect of intravenous phenylephrine infusion on dose requirement of intrathecal plain levobupivacaine for cesarean section: A placebo-controlled preliminary study. Saudi J Anaesth [serial online] 2017 [cited 2021 Dec 8 ];11:421-426
Available from: https://www.saudija.org/article.asp?issn=1658-354X;year=2017;volume=11;issue=4;spage=421;epage=426;aulast=Tyagi;type=0