Randomized Double-Blind Study of the Effect of Injectate Temperature on Intrathecal Bupivacaine Dose Requirement in Spinal Anesthesia for Cesarean Delivery

Overview

Journal Anesth Analg

Specialty Anesthesiology

Date 2024 Jun 13

PMID 38870069

Authors

Yan-Ping Zhao

Xu-Feng Zhang

Jing Qian

Fei Xiao

Xin-Zhong Chen

Affiliations

Soon will be listed here.

Abstract

Background: Increasing the temperature of intrathecal local anesthetics has been shown to increase the speed of onset and block height of spinal anesthesia. However, how this influences dose requirement has not been fully quantified. The aim of this study was to determine and compare the effective dose for anesthesia for cesarean delivery in 50% of patients (ED 50 ) of intrathecal bupivacaine given at temperatures of 37 °C (body temperature) or 24 °C (room temperature).

Methods: Eighty healthy parturients having elective cesarean delivery under combined spinal-epidural anesthesia were randomly assigned to receive intrathecal hyperbaric bupivacaine stored at 37 °C (body temperature group) or 24 °C (room temperature group). The first subject in each group received a bupivacaine dose of 10 mg. The dose for each subsequent subject in each group was varied with an increment or decrement of 1 mg based on the response (effective or noneffective) of the previous subject. Patients for whom the dose was noneffective received epidural supplementation after data collection with lidocaine 2% as required until anesthesia was sufficient for surgery. Values for ED 50 were calculated using modified up-down sequential analysis with probit analysis applied as a backup sensitivity analysis. These values were compared and the relative mean potency was calculated.

Results: The ED 50 (mean [95% confidence interval, CI]) of intrathecal hyperbaric bupivacaine was lower in the body temperature group (6.7 [5.7-7.6] mg) compared with the room temperature group (8.1 [7.7-8.6] mg) ( P < .05). The relative potency ratio for intrathecal bupivacaine for the room temperature group versus the body temperature group was 0.84 (95% CI, 0.77-0.93).

Conclusions: Warming hyperbaric bupivacaine to body temperature reduced the dose requirement for spinal anesthesia for cesarean delivery by approximately 16% (95% CI, 7%-23%).

References

Chambers W, Edstrom H, Scott D . Effect of baricity on spinal anaesthesia with bupivacaine. Br J Anaesth. 1981; 53(3):279-82. DOI: 10.1093/bja/53.3.279. View

Xiao F, Drzymalski D, Liu L, Zhang Y, Wang L, Chen X . Comparison of the ED50 and ED95 of Intrathecal Bupivacaine in Parturients Undergoing Cesarean Delivery With or Without Prophylactic Phenylephrine Infusion: A Prospective, Double-Blind Study. Reg Anesth Pain Med. 2018; 43(8):885-889. DOI: 10.1097/AAP.0000000000000850. View

Uppal V, Retter S, Casey M, Sancheti S, Matheson K, McKeen D . Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Anesth Analg. 2019; 130(1):111-125. DOI: 10.1213/ANE.0000000000003975. View

Nazli B, Oguzalp H, Horasanli E, Gamli M, Dikmen B, Gogus N . The effects on sensorial block, motor block, and haemodynamics of levobupivacaine at different temperatures applied in the subarachnoid space. Biomed Res Int. 2014; 2014:132687. PMC: 3977099. DOI: 10.1155/2014/132687. View

MacPherson H . Pragmatic clinical trials. Complement Ther Med. 2004; 12(2-3):136-40. DOI: 10.1016/j.ctim.2004.07.043. View

Elsharkawy R, Messeha M, Elgeidi A . The Influence of Different Degrees of Temperature of Intrathecal Levobupivacaine on Spinal Block Characteristics in Orthopedic Surgeries: A Prospective Randomized Study. Anesth Essays Res. 2019; 13(3):509-514. PMC: 6775827. DOI: 10.4103/aer.AER_76_19. View

Sng B, Han N, Leong W, Sultana R, Siddiqui F, Assam P . Hyperbaric vs. isobaric bupivacaine for spinal anaesthesia for elective caesarean section: a Cochrane systematic review. Anaesthesia. 2017; 73(4):499-511. DOI: 10.1111/anae.14084. View

Huang S, Chau A, Shapiro A, Prabhakar C . Effect of temperature on the density, local anesthetic, and glucose concentrations of 0.75% hyperbaric bupivacaine for spinal anesthesia. Can J Anaesth. 2019; 67(5):617-618. DOI: 10.1007/s12630-019-01549-8. View

Sanchez V, Arthur G, Strichartz G . Fundamental properties of local anesthetics. I. The dependence of lidocaine's ionization and octanol:buffer partitioning on solvent and temperature. Anesth Analg. 1987; 66(2):159-65. View

10.

Smiley R, Redai I . More failed spinal anesthetics with hyperbaric bupivacaine. Int J Obstet Anesth. 2004; 13(2):131-4. DOI: 10.1016/j.ijoa.2004.01.004. View

11.

Higuchi H, Hirata J, Adachi Y, Kazama T . Influence of lumbosacral cerebrospinal fluid density, velocity, and volume on extent and duration of plain bupivacaine spinal anesthesia. Anesthesiology. 2003; 100(1):106-14. DOI: 10.1097/00000542-200401000-00019. View

12.

Arai Y, Ueda W, Takimoto E, Manabe M . The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia. Anesth Analg. 2005; 102(1):272-5. DOI: 10.1213/01.ANE.0000184252.16045.0E. View

13.

Schiffer E, Van Gessel E, Fournier R, Weber A, Gamulin Z . Cerebrospinal fluid density influences extent of plain bupivacaine spinal anesthesia. Anesthesiology. 2002; 96(6):1325-30. DOI: 10.1097/00000542-200206000-00010. View

14.

Sviggum H, Yacoubian S, Liu X, Tsen L . The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study. Int J Obstet Anesth. 2014; 24(1):15-21. DOI: 10.1016/j.ijoa.2014.07.001. View

15.

Choi S . Interval estimation of the LD50 based on an up-and-down experiment. Biometrics. 1990; 46(2):485-92. View

16.

Stienstra R, van Poorten J . The temperature of bupivacaine 0.5% affects the sensory level of spinal anesthesia. Anesth Analg. 1988; 67(3):272-6. View

17.

Heller A, Zimmermann K, Seele K, Rossel T, Koch T, Litz R . Modifying the baricity of local anesthetics for spinal anesthesia by temperature adjustment: model calculations. Anesthesiology. 2006; 105(2):346-53. DOI: 10.1097/00000542-200608000-00018. View

18.

Pace N, Stylianou M . Advances in and limitations of up-and-down methodology: a précis of clinical use, study design, and dose estimation in anesthesia research. Anesthesiology. 2007; 107(1):144-52. DOI: 10.1097/01.anes.0000267514.42592.2a. View

19.

Payton M, Greenstone M, Schenker N . Overlapping confidence intervals or standard error intervals: what do they mean in terms of statistical significance?. J Insect Sci. 2005; 3:34. PMC: 524673. DOI: 10.1093/jis/3.1.34. View

20.

Hallworth S, Fernando R, Columb M, Stocks G . The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg. 2005; 100(4):1159-1165. DOI: 10.1213/01.ANE.0000149548.88029.A2. View