Robert A Dyer1, Ivan A Joubert. 1. Department of Anaesthesia, University of Cape Town and New Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, South Africa. dyer@cormack.uct.ac.za
Abstract
PURPOSE OF REVIEW: The literature on the appropriate dose of local anaesthetic and combinations with opioids for spinal anaesthesia for caesarean section in patients without comorbid conditions is reviewed. The controversial issue of spinal anaesthesia in severe preeclampsia is also addressed. RECENT FINDINGS: Recent comparisons with ropivacaine and levobupivacaine suggest that bupivacaine remains the best agent for spinal anaesthesia for caesarean section. The addition of various combinations of opioids has allowed a reduction in the dose of bupivacaine. Intrathecal diamorphine has been extensively investigated and appears to have a favourable pharmacokinetic and pharmacodynamic profile. In severe preeclampsia, spinal anaesthesia may be associated with less hypotension than in healthy parturients, where similar doses of local anaesthetic are used. SUMMARY: Low-dose spinal anaesthesia has been advocated in the interests of improving cardiovascular stability. However, current sophistication of knowledge concerning spinal anaesthetic technique makes cardiovascular instability easy to prevent. Therefore this review emphasizes the importance of adequate surgical anaesthesia during caesarean section, and makes suggestions as to the optimal pharmacological agents for intraoperative anaesthesia and postoperative analgesia. Spinal anaesthesia is safe in severe preeclampsia, provided there are no contraindications to regional anaesthesia.
PURPOSE OF REVIEW: The literature on the appropriate dose of local anaesthetic and combinations with opioids for spinal anaesthesia for caesarean section in patients without comorbid conditions is reviewed. The controversial issue of spinal anaesthesia in severe preeclampsia is also addressed. RECENT FINDINGS: Recent comparisons with ropivacaine and levobupivacaine suggest that bupivacaine remains the best agent for spinal anaesthesia for caesarean section. The addition of various combinations of opioids has allowed a reduction in the dose of bupivacaine. Intrathecal diamorphine has been extensively investigated and appears to have a favourable pharmacokinetic and pharmacodynamic profile. In severe preeclampsia, spinal anaesthesia may be associated with less hypotension than in healthy parturients, where similar doses of local anaesthetic are used. SUMMARY: Low-dose spinal anaesthesia has been advocated in the interests of improving cardiovascular stability. However, current sophistication of knowledge concerning spinal anaesthetic technique makes cardiovascular instability easy to prevent. Therefore this review emphasizes the importance of adequate surgical anaesthesia during caesarean section, and makes suggestions as to the optimal pharmacological agents for intraoperative anaesthesia and postoperative analgesia. Spinal anaesthesia is safe in severe preeclampsia, provided there are no contraindications to regional anaesthesia.