Low Dose of Intrathecal Hyperbaric Bupivacaine Combined with Epidural Lidocaine for Cesarean Section ??? A Balance Block Technique

Abstract

The present study was designed to develop a combined spinal/epidural anesthetic technique for cesarean section. We compared the effects of different doses of intrathecal hyperbaric bupivacaine (0.5%) combined with epidural lidocaine (2%). We attempted to interrupt somatosensory pathways with spinal anesthesia but to avoid acute high thoracic sympathetic block. The visceral afferent pathways were to be blocked relatively slowly with epidural lidocaine. Eighty term parturients were randomly divided into four groups. In Group A, 2.5 mg of bupivacaine intrathecally combined with 22.2 +/- 4.6 mL of lidocaine epidurally provided insufficient muscle relaxation. In Group B, 5 mg of bupivacaine with 10.1 +/- 2.0 mL of lidocaine resulted in satisfactory anesthesia with rapid onset and minimum side effects. Anesthesia in Group C (7.5 mg of bupivacaine) and Group D (10 mg of bupivacaine) was mostly due to spinal block. Complications included hypotension, nausea, and dyspnea. The combined spinal/epidural technique, using 5 mg of bupivacaine and with sufficient epidural lidocaine to reach a T4 level, had the advantages of both spinal and epidural anesthesia with few of the complications of either.