@article{3092384,
    title = "Spread of subarachnoid block, intraoperative local anaesthetic
requirements and postoperative analgesic requirements in Caesarean
section and total abdominal hysterectomy",
    author = "Fassoulaki, A and Gatzou, V and Petropoulos, G and Siafaka, I",
    journal = "BRITISH JOURNAL OF ANAESTHESIA",
    year = "2004",
    volume = "93",
    number = "5",
    pages = "678-682",
    publisher = "Elsevier Sci Ltd, Exeter, United Kingdom",
    issn = "0007-0912",
    doi = "10.1093/bja/aeh258",
    keywords = "anaesthesia, obstetric, Caesarean section; anaesthetic techniques,
subarachnoid; analgesia, patient-controlled; analgesics opioid;
morphine; pain, postoperative",
    abstract = "Background. Pregnancy is associated with a higher spread of subarachnoid
anaesthesia and increased pain threshold. The study was designed to
assess the spread of subarachnoid block and the intra- and postoperative
analgesic requirements in pregnant vs non-pregnant women.
Methods. We assessed the level of subarachnoid anaesthesia after 1.8 ml
of hyperbaric lidocaine 5% and the postoperative analgesic requirements
in women undergoing Caesarean section and undergoing abdominal
hysterectomy (30 each group). Intraoperatively epidural ropivacaine was
given as required. All patients received 10 ml of ropivacaine 0.2%
epidurally 2, 10, and 24 h after operation and the VAS pain score was
assessed. They also had access to patient controlled analgesia i.v.
morphine.
Results. Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001)
in the pregnant and non-pregnant groups. Ten minutes after subarachnoid
injection, sensory block was higher by three dermatomes in the pregnant
group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19
(12.2) min (P<0.001) and the ropivacaine normalized for the duration of
anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant
and non-pregnant groups, respectively. The time between the first and
second ropivacaine dose was similar in the two groups (P=0.070). Fewer
pregnant women (81 vs 100%) required ropivacaine intraoperatively
(P=0.017). The VAS scores were similar but parturients consumed more
i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h
after operation.
Conclusions. Pregnant patients exhibited a higher level of subarachnoid
sensory block and required more i.v. morphine after operation."
}