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

Antecedentes En una cesarea se puede emplear analgesia epidural con bupivacaina 0.125% and lidocaina 1.5% o bupivacaina 0.25% and lidocaina 1.0%. Una concentracion mayor de bupivacaina alcanza mayor analgesia con mas eventos adversos. OBJETIVO evaluar la analgesia y seguridad de bupivacaina 0.125% and lidocaina 1.5% o bupivacaina 0.25% and lidocaina 1.0%. MATERIALES Y METODOS Cohorte prospectivo estratificado segun ambas concentraciones de bupivacaina. RESULTADOS Se recupero cien gestantes a termino (cincuenta por cohorte). A los 20 y 30 minutos tras la administracion epidural hubo mas casos con mayor bloqueo motor en quienes se empleo bupivacaina 0.125% and lidocaina 1.5% (p = 0.0229 y p = 0.0006, respectivamente). No hubo diferencia significativa respecto al bloqueo sensitivo. Bupivacaina 0.25% and lidocaina 1.5% mostro una tencencia a la hipotension (p < 0.001) y a la bradicardia (p = 0.4100). De la cohorte de bupivacaina 0.125% and lidocaina 1.5%, 25 casos (50%) presentaron cuando menos un evento adverso, en contraste con 44/50 (88%) de la cohorte de bupivacaina 0.25% and lidocaina 1.0% (p < 0.001). CONCLUSION En la analgesia epidural durante cesarea, bupivacaina 0.125% and lidocaina 1.5% esta asociado con un efecto analgesico similar a bupivacaina 0.25% and lidocaina 1.0%. Sin embargo, mayores concentraciones estan significativamente relacionadas con mayor tasa de eventos adversos (especialmente hipotension). 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).