Sarcouncil Journal of Medicine and Surgery

Abstract: Background: Inadequate block, hypotension, nausea, and vomiting are common adverse effects of a single-shot spinal anesthetic used for cesarean deliveries. The study's goal: In this study, three distinct intrathecal (IT) hyperbaric bupivacaine 0.5% doses—5 mg, 7.5 mg, and 10 mg each—mixed with 25 µg of fentanyl were used to examine the anesthetic and side effects of combination spinal epidural anesthesia for cesarean birth. Methods: Each of the three groups was assigned at random to seventy-eight healthy women who were presenting for an elective cesarean birth. When combined spinal-epidural anesthesia was started, 5 mg (IT) of hyperbaric bupivacaine 0.5% was given to Group A, 7.5 mg to Group B, and 10 mg to Group C. IT bupivacaine was premixed with 25µg of fentanyl in each group. Following a full motor block of the lower limbs and the achievement or extension of the sensory level of T4 using epidural supplements, surgery started. When the amount of motor block reached Bromage level 3 and the full loss of feeling to ice reached the fourth thoracic dermatome T4, the IT block was considered successful. Results: There was no statistically significant difference in the three groups' preoperative data. 46.2% of group A, 80.8% of group B, and 92.3% of group C attained the best upper sensory block T4 (p-value = 0.003). Group A had the greatest rates of maternal intraoperative pain (69.2%), whereas groups B and C had lower and similar rates (26.9%). The effectiveness of epidural extension supplements in reducing patient discomfort was evident in all three groups: group A (65.4%), group B (19.2%), and group C (3.8%). The frequency of maternal hypotension was found to be greater with raising the dose of IT bupivacaine; 42 percent with group A 5mg, 73% in group B 7.5mg and 77% in group C 10 mg. Conclusion: When combined with 25µg fentanyl, intrathecal bupivacaine at doses of 5 mg, 7.5 mg, or 10 mg during CSE for cesarean delivery resulted in an effective block with a greater incidence of hypotension for 7.5 mg and 10 mg, whereas 5 mg of bupivacaine maintained maternal hemodynamic stability but was unable to produce sufficient anesthesia unless epidural extension took place prior to skin incision.