EFFECT OF TEMPERATURE VARIATION ON QUALITY OF SPINAL ANAESTHESIA USING 0.5% BUPIVACAINE IN PATIENTS UNDERGOING CESAREAN SECTION
Main Article Content
Keywords
Bupivacaine, Cesarean Section, Sensory Block, Shivering, Spinal Anesthesia, Warming
Abstract
Background: Spinal anesthesia with intrathecal bupivacaine is widely used for cesarean sections. However, the temperature of bupivacaine may influence the onset, spread of sensory block, and incidence of shivering. Warming the anesthetic solution could enhance block characteristics and reduce perioperative discomfort.
Objective: To compare the effects of room temperature versus warmed intrathecal bupivacaine on sensory block levels and shivering incidence in patients undergoing cesarean section under spinal anesthesia.
Study Design & Setting: A randomized controlled trial conducted at Department of Anaesthesia, Abbasi Shaheed Hospital, Karachi from 14th June 2022 till 15th December 2022.
Methods: A total of 142 parturients scheduled for elective cesarean section were randomly allocated into two groups: Group A received room temperature bupivacaine (n=71), and Group B received warmed bupivacaine (n=71). Sensory dermatomal levels were assessed, and the incidence of shivering was recorded intraoperatively. Statistical analysis compared the onset, extent of sensory block, and shivering frequency between groups.
Results: The warmed bupivacaine group achieved higher sensory levels, with 21% and 61% of patients reaching T4 and T5 levels respectively, compared to 4% and 18% in the room temperature group. Shivering occurred less frequently in Group B (31%) compared to Group A (69%), though this difference did not reach statistical significance (p=0.111). The warmed group exhibited faster onset and better cephalad spread of sensory blockade.
Conclusion: Warming intrathecal bupivacaine significantly improves sensory block characteristics and tends to reduce the incidence of shivering during cesarean sections under spinal anesthesia. These findings support the clinical advantage of warming bupivacaine to enhance anesthetic efficacy and patient comfort.
References
2. Dhakal-Rai S, van Teijlingen E, Regmi P, Wood J, Dangal G, Dhakal KB. A brief history and indications for cesarean section. Journal of Patan Academy of Health Sciences. 2021 Oct 10;8:e1-0.
3. Garg B, Bansal T, Mehta N, Sharan AD. Patient positioning in spine surgery: what spine surgeons should know?. Asian Spine Journal. 2023 May 25;17(4):770.
4. Elsharkawy RA, Messeha MM, Elgeidi AA. The influence of different degrees of temperature of intrathecal levobupivacaine on spinal block characteristics in orthopedic surgeries: a prospective randomized study. Anesthesia Essays and Researches. 2019 Jul 1;13(3):509-14.
5. Haberer JP, Dalens BJ. Local anesthetics and additives. InPediatric regional anesthesia 2019 Aug 15 (pp. 91-126). Routledge.
6. Zaza KJ, Hopf HW. Thermoregulation: Normal physiology, anesthetic effects, and perioperative considerations. InPharmacology and Physiology for Anesthesia 2019 Jan 1 (pp. 300-310).
7. Stav M, Matatov Y, Hoffmann D, Heesen P, Gliesche V, Binyamin Y, Ioscovich A, Eidelman LA, Orbach‐Zinger S. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: a retrospective observational study. Acta Anaesthesiologica Scandinavica. 2023 Jan;67(1):29-35.
8. Otto KA. Physiology, pathophysiology, and anesthetic management of patients with neurologic disease. Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones. 2015 Apr 29:557-83.
9. Yu S, Wang B, Zhang J, Fang K. The development of local anesthetics and their applications beyond anesthesia. Int J Clin Exp Med. 2019 Jan 1;12(12):13203-20.
10. Tubog TD, Ramsey VL, Filler L, Bramble RS. Minimum effective dose (ED50 and ED95) of intrathecal hyperbaric bupivacaine for cesarean delivery: a systematic review. AANA J. 2018 Oct 1;86(5):348-60.
11. Olawin AM, M Das J. Spinal Anesthesia. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021. PMID: 30725984.
12. Ferede YA, Aytolign HA, Mersha AT. “The magnitude and associated factors of intraoperative shivering after cesarean section delivery under Spinal anesthesia’’: A cross sectional study. Annals of Medicine and Surgery. 2021 Dec 1;72:103022.
13. Blumenberg A. Dosing heat: expected core temperature change with warmed or cooled intravenous fluids. Therapeutic Hypothermia and Temperature Management. 2021 Dec 1;11(4):223-9.
14. Aydin, G. & Süslü, A & Özlü, O & Aksoy, Mustafa & Polat, Reyhan. (2011). The Influence of Temperature on Spread of Intrathecal Levobupivacaine. The Internet Journal of Anesthesiology. 29. 1‐6.
15. Feng G, Wang Y, Feng J, Luo X, Li C, Yao S. The relationship between core temperature and perioperative shivering during caesarean section under intrathecal anesthesia with bupivacaine and ropivacaine: a randomized controlled study. Journal of anesthesia. 2021 Dec;35(6):889‐95.
16. Kishore N, Payal YS, Kumar N, Chauhan N. In spinal anaesthesia for cesarean section the temperature of bupivacaine affects the onset of shivering but not the incidence: a randomized control trial. Journal of Clinical and Diagnostic Research: JCDR. 2016 Jan;10(1):UC18.
17. Thakur N, Balachander H, Rudingwa P, Panneerselvam S. Shivering and changes in body temperature in patients undergoing caesarean section under spinal anaesthesia with bupivacaine vs bupivacaine and fentanyl: A randomized clinical study. Journal of Anaesthesiology Clinical Pharmacology. 2023 Jan 1;39(1):67-73.
18. Khan MK, Hafiz A, Feroze F, Tahir AA, Farooq S, Faheem MS. Comparison of hemodynamic effect caused by intrathecal low dose administration of 0.5% against 0.75% hyperbaric bupivacaine in patients undergoing lower limb surgery under unilateral spinal anaesthesia. Journal of Ayub Medical College Abbottabad. 2023 Dec 22;35(4):549-52.
19. Javed KH, Ishrat ZA, Akhtar N, Ijaz B. Comparative study of intrathecal 0.5% isobaric versus 0.5% hyperbaric bupivacaine in same volume and dose to assess the quality of spinal anaesthesia and haemodynamic changes occurring during cesarean section. Pakistan J Med Health Sci. 2014 Apr 1;8(2):407-10.
20. Shahid M, Sibtain A, ul Islam M, Ahmed I, Khan B, Shakil R, Ali FA. Comparison of the Effect of Intrathecal Hyperbaric 0.5% Bupivacaine Alone and With Addition of Dexemedetomidine on First Analgesic Request in Post-Operative Care Unit Following Elective Cesarean Section: Bupivacaine alone and with addition of Dexemedetomidine on duration of anesthesia following c-section. Pakistan BioMedical Journal. 2022 Jan 31:54-8.
21. Al-Mandhari KM, Al-Shukaili AA, Younis B, Lad S, Khan RM, Kaul N. Effects of 0.5% heavy bupivacaine at room versus body temperature on shivering and analgesia after spinal anesthesia in patients undergoing cesarean section. Indian Journal of Pain. 2019 May 1;33(2):77-80.
22. Naveena P, Naveenkumar P, Kumar A, Shanmugasundaram S, Choudhary AK, Periasamy P. Effect of injection speed of hyperbaric bupivacaine 0.5% in spinal anesthesia on block quality and hemodynamic changes in elective cesarean sections. Anaesthesia, Pain & Intensive Care. 2025 Feb 4;29(1):105-11.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Safia Iqbal
MBBS, FCPS, Senior Registrar Department of Anaesthesia, Dow University Hospital, Karachi
Shumaila Motiwala
MBBS, FCPS, Senior Registrar Department of Anaesthesia, Dow University Hospital, Karachi
Sumreen Arif
MBBS, FCPS, Senior Registrar Department of Anaesthesia, Dow University Hospital, Karachi
Muneeba Arshad
MBBS, FCPS, Assistant Professor Department of Anaesthesia, Dow University Hospital, Karachi
Tooba Usman
MBBS, FCPS, Senior Registrar Department of Anaesthesia, Dow University Health Sciences, OJHA Campus
Aftab Imtiaz
MBBS, FCPS, Professor & Head of Department of Anaesthesia, KMDC &Abbasi Shaheed Hospital, Karachi