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Anesth Essays Res. 2019 Oct-Dec;13(4):663-668. doi: 10.4103/aer.AER_131_19. Epub 2019 Dec 16.

Large Dose Bupivacaine 0.5% versus Small Dose in Elective Cesarean Section.

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Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Cairo, Egypt.


Background and Aim:

The spinal anesthesia in a cesarean section is still presenting a challenge to the anesthetist in the form of either severe hypotension from large bupivacaine dose or insufficient satisfactory anesthesia level conditions as a result of small bupivacaine dose. In this study, we tried to solve this challenge by increasing the dose of bupivacaine to achieve a proper spinal level accompanied by prolonged sitting up to avoid hypotension.

Patients and Methods:

We included 53 patients in this study whom were randomly divided into two groups, namely Group B and Group C. In Group B (25 patients), each patient received 3 mL of bupivacaine and left 5 min sitting up, whereas in Group C (28 patients), each patient received 2.5 mL of bupivacaine and was asked to lie supine immediately. Both groups were tested for hypotension, ephedrine dose, and sensory block level.


The present study showed a statistically significant lower dose of ephedrine which was given in Group B (7.2 ± 15.684 mg in Group B versus 27.86 ± 12.04 mg in Group C with P < 0.05). The proper anesthesia level was achieved equally in both groups.


Large dose 15 mg of bupivacaine with the prolonged sitting position will lead to fewer incidences of hypotension and proper anesthesia block.


Ephedrine; hypotension; spinal anesthesia

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