ESRA Academy. Retter S. Sep 8, 2016; 138330; 0164 Topic: Spinal Anaesthesia - Analgesia
Dr. Susanne Retter
Dr. Susanne Retter

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Background and Aims:

There are two commercially available formulations of bupivacaine; isobaric bupivacaine (IB) and hyperbaric bupivacaine (HB). Aim of this study was to systematically review the evidence regarding the effectiveness and safety of the two formulations when used for spinal anesthesia. 


The key electronic databases (Medline, Embase, Cochrane) were searched for randomized controlled trials (RCTs). Caesarean section surgery was excluded. No language or date restrictions were applied. Two reviewers independently extracted the data using a standardized form.


751 studies were identified between 1946 and 2015. After screening, sixteen RCTs (including 724 participants) provided data for the meta-analysis. There was no significant difference between the two drugs regarding conversion to GA (RR 0.60, 95% CI 0.08-4.41; p=0.62). Furthermore, no difference between the two drugs was observed regarding the incidence of hypotension (p=0.58) and nausea/vomiting (p=0.11). The onset of motor block was significantly faster with HB (Mean difference 4.03 min, 95% CI 0.82-4.7.24; p=0.01). The duration of sensory and motor block was longer in IB group (Mean difference 26.1 min, 95% CI 11.5-40.8; p<0.001) and (Mean difference 58.6 min, 95% CI 29.3-88; p<0.0001) respectively. 


Both HB and IB provided effective anesthesia with high success rate with no difference in conversion to GA and adverse effects.  However, HB showed a significant faster onset and a shorter duration of anesthesia when compared to IB. The information from this review provides useful information to guide clinical decision regarding the choice of bupivacaine formulation for spinal anesthetic.

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