This is a prospective, randomized, double blind study of 75 patients (n=25 for each group) in
which epinephrine (100mcg or 200mcg) or normal saline vehicle is added to intrathecal
hyperbaric bupivacaine (0.75% bupivacaine hydrochloride in 8.25% dextrose), fentanyl, and
morphine to prolong the duration of the spinal anesthetic in scheduled cesarean deliveries.
The primary outcome of duration will be the time to T10 level sensory regression as well as
motor level regression that will be graded via the modified Bromage scale.
Repeat cesarean sections, in particular, are associated with increased operative time and
thus often performed with a spinal-epidural (CSE) technique. The epidural component is,
however, untested and may not provide adequate anesthesia, thus the higher risk of conversion
to a general anesthesia. Epinephrine is routinely used to prolong spinal anesthesia. If
effective for the duration of a repeat cesarean section it would obviate the additional time
and risks of performing the epidural and still avoid sufficient duration to avoid conversion
to a general anesthetic.
Many counties in sub-Saharan Africa have very limited post-operative nursing capacity, and
relatively little data have been published about post-operative maternal pain control in
these settings. Cesarean section is the most common type of major operation at our
institution, Mbarara Regional Referral Hospital (MRRH), in south-western Uganda.Nursing ward
staffing capacity is low, with much basic nursing care provided by families and friends of
patients. The investigators conducted a study to examine the impact of ITM versus TAP block
in a setting of limited formal nursing oversight.
The objective of this study is to evaluate the effect of intrathecal hydromorphone on the
duration of labor analgesia and the incidence of epidural-associated temperature increase in
laboring parturients. We hypothesize that intrathecal administration of longer-acting
hydromorphone will:
1. Prolong the duration and improve the quality of analgesia in labor, and
2. Decrease the incidence of epidural-associated temperature increase in labor.
This is a study of pregnant women undergoing a cesarean delivery. It will compare their
microcirculation before and after the anesthetic. Microcirculation means blood flow to the
extremely small blood vessels in the body. It will also look at the differences in
microcirculation of participants who receive an infusion of phenylephrine compared to
participants who don’t. The investigators hypothesize that spinal anesthesia will reduce the
vascular density and proportion of perfused vessels.
The aim of this study is to compare two different therapeutic approaches to blood pressure
reduction: pharmacological vs. non-pharmacological. The setting is that of patients
undergoing scheduled Cesarean section under spinal anesthesia and suffering from aorta-caval
compression syndrome, which causes a sudden drop in blood pressure.
