Summary

• Dose: 2.2-2.3 ml (11-11.5 mg) 0.5% hyperbaric bupivacaine + 15 mcg fentanyl + 100 mcg morphine

• Position: Sitting or lateral, immediately supine.

• Expectation: Surgical block for up to 90 minutes post-spinal.

Evidence

• Ginosar et al. reported an ED95 of 11.2 mg hyperbaric bupivacaine (in conjunction with 10 mcg fentanyl & 200 mcg morphine) [1]. These procedures included routine uterine exteriorisation, and a mean surgical time of 64 minutes.

• Xiao et al. reported an ED95 of 11.7 mg hyperbaric bupivacaine (without opioid) [2]. Mean surgical time was 42-44 minutes.

References

1. Ginosar et al. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology 2004;100:676-682.

2. Xiao et al. Comparison of the ED50 and ED95 of intrathecal bupivacaine in patients undergoing cesarean delivery with or without prophylactic phenylephrine infusion.  Reg Anesth & Pain Med 2018;43:885-889.