Newly Published
Perioperative Medicine  |   July 2017
Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial
Author Notes
  • From the Department of Anesthesiology (L.A.C., J.R.B., N.H., P.T., F.M.P., J.F., R.J.M., J.T.S.) and Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology (S.E.G.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; Current Position: Anesthesia Practice Consultants, Grand Rapids, Michigan (L.A.C.).
  • Part of the work presented in this article has been presented as an abstract at the Best of Abstracts Clinical Science session at the American Society of Anesthesiologists meeting in Chicago, Illinois, October 22, 2016.
    Part of the work presented in this article has been presented as an abstract at the Best of Abstracts Clinical Science session at the American Society of Anesthesiologists meeting in Chicago, Illinois, October 22, 2016.×
  • Submitted for publication January 24, 2017. Accepted for publication June 19, 2017.
    Submitted for publication January 24, 2017. Accepted for publication June 19, 2017.×
  • Research Support: Supported by grant No. 69779 from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (Princeton, New Jersey; to Dr. Toledo) and the Department of Anesthesiology, Northwestern University Feinberg School of Medicine (Chicago, Illinois).
    Research Support: Supported by grant No. 69779 from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (Princeton, New Jersey; to Dr. Toledo) and the Department of Anesthesiology, Northwestern University Feinberg School of Medicine (Chicago, Illinois).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: sullivan@northwestern.edu. Raw data available at: sullivan@northwestern.edu.
    Reproducible Science: Full protocol available at: sullivan@northwestern.edu. Raw data available at: sullivan@northwestern.edu.×
  • Correspondence: Address correspondence to Dr. Sullivan: 250 E. Huron Street, F 5-704, Chicago, Illinois 60611. sullivan@northwestern.edu.Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia / Pharmacology
Perioperative Medicine   |   July 2017
Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial
Anesthesiology Newly Published on July 19, 2017. doi:10.1097/ALN.0000000000001796
Anesthesiology Newly Published on July 19, 2017. doi:10.1097/ALN.0000000000001796
Abstract

Background: Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose–response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success.

Methods: We conducted a randomized, double-blind trial to assess the effect of four intrathecal bupivacaine doses (2.5, 5.0, 7.5, 10.0 mg) combined with fentanyl 15 μg on the success rate of external cephalic version for breech presentation. Secondary outcomes included mode of delivery, indication for cesarean delivery, and length of stay.

Results: A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004).

Conclusions: A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.