Table 1.
Characteristics of analyzed trials
| Refs. | Year | Number of parturient | Drug regimen | Anesthesia | Age | Weight (kg) | Height (cm) | Primary endpoints |
|---|---|---|---|---|---|---|---|---|
| Atalay C (14) | 2010 | 20 | 10 mg bupivacaine | S | 27.8 ± 4.3 | 75.0 ± 3.4 | 160 ± 5.1 | Hypotensiona (MBP decreased by more than 15–20% from baseline), introoperative analgesia (0–10VAS), comfort (poor, fair, good, excellent) |
| 20 | 5 mg bupivacaine + 35 mg meperidine | 28.4 ± 5.4 | 74.0 ± 4.5 | 162 ± 4.3 | ||||
| 20 | 5 mg bupivacaine + 30 mg meperidine | 26.9 ± 6.8 | 73.0 ± 5.3 | 159 ± 5.2 | ||||
| 20 | 5 mg bupivacaine + 25 mg meperidine | 29.6 ± 5.4 | 75.0 ± 6.1 | 161 ± 5.4 | ||||
| Turhanoglu S (11) | 2009 | 20 | 10 mg bupivacaine | CSE | 28.2 ± 4.9 | 79.5 ± 7.7 | 162 ± 2.6 | Hypotension (SAP <90 mmHg or 30% decrease from the baseline), introoperative analgesia (a 10‐cm linear VAS), satisfaction with anesthetic (very bad, bad, good, very good) |
| 20 | 4 mg bupivacaine + 25 μg fentanyl | 27.3 ± 6.3 | 79.4 ± 5.3 | 161 ± 1.8 | ||||
| Agrawal A (16) | 2009 | 20 | 12 mg bupivacaine | S | 27.4 ± 4.49 | 57.5 ± 3.03 | 158 ± 3.30 | Hypotension (fall of blood pressure greater than 20% of baseline) |
| 20 | 7.5 mg bupivacaine + 25 μg fentanyl | 25.9 ± 3.32 | 55.9 ± 2.10 | 157 ± 2.96 | ||||
| 20 | 7.5 mg bupivacaine + 10 μg sufentanil | 25.7 ± 2.50 | 56.2 ± 4.55 | 156.2 ± 4.61 | ||||
| Tolia G (17) | 2008 | 25 | 11 mg bupivacaine | S | 25.1 ± 3.47 | 57.0 ± 7.40 | 157 ± 4.45 | Hypotension (SBP<95 mmHg or SBP decreased >25% from baseline value), quality of surgical anesthesia (poor, good, excellent) |
| 25 | 9 mg bupivacaine + 10 μg fentanyl | 24.1 ± 3.86 | 57.5 ± 5.51 | 156 ± 4.62 | ||||
| 25 | 7.5 mg bupivacaine + 10 μg fentanyl | 26.0 ± 4.36 | 58.4 ± 5.25 | 157 ± 4.83 | ||||
| Sivevski A (18) | 2006 | 20 | 13.5 mg bupivacaine | S | 26.0 ± 7.5 | 74.5 ± 10 | 164 ± 7 | Hypotension (SBP was lower than 95 mm Hg or 20% below the preinduction level), introoperative analgesia (VAS) |
| 20 | 9 mg bupivacaine+ 20μg fentanyl | 27.2 ± 4.7 | 76.0 ± 8 | 165 ± 5 | ||||
| Kiran S (12) | 2002 | 20 | 7.5 mg bupivacaine | S | 23.2 ± 3.03 | 59.3 ± 9.40 | 157 ± 6.24 | Hypotension (a decrease of SBP of 30% from baseline), introoperative analgesiab (poor, fair, good, excellent) |
| 20 | 8.75 mg bupivacaine | 24.8 ± 2.95 | 58.4 ± 9.07 | 62.7 ± 11.7 | ||||
| 20 | 10 mg bupivacaine | 25.4 ± 4.46 | 62.7 ± 11.7 | 9.82 ± 0.82 | ||||
| Ben‐David B (13) | 2000 | 16 | 10 mg bupivacaine | S | 32.6 ± 4.7 | 84.7 ± 9.0 | 164 ± 4.9 | Hypotension (SBP less than 95 mm Hg or a decrease of more than 25% from baseline), satisfaction of anesthetic (VAS) |
| 16 | 5 mg bupivacaine + 25 μg fentanyl | 29.0 ± 7.5 | 84.8 ± 13.8 | 164 ± 5.5 | ||||
| Chung CJ (19) | 1996 | 20 | 8–9 mg bupivacaine | S | 30.0 (23–34)c | 159.5 ± 2.4 | 159 ± 2.4 | Hypotension (SAP less than 100 mmHg or a 20% reduction of SAP), introoperative analgesiab (poor, fair, good, excellent) |
| 20 | 9–10 mg bupivacaine | 29.9(25–35)c | 159 ± 2.2 | 159 ± 2.2 | ||||
| 20 | 10–11 mg bupivacaine | 29.4 (24–36)c | 161 ± 2.7 | 161 ± 2.7 | ||||
| Thorén T (20) | 1994 | 21 | 12.5 mg bupivacaine | S | 28.8 ± 0.9 | 75.9 ± 2.2 | 164± 1.6 | Hypotension (a decrease in SBP of 20% or more from baseline value, or a SBP below 100 mm Hg), introoperative analgesiab (poor, fair, good, excellent) |
| 21 | 7.5 mg bupivacaine | CSE | 31.1 ± 1.0 | 75.1 ± 2.4 | 166 ± 1.3 | |||
| Fan SZ (1) | 1994 | 20 | 2.5 mg bupivacaine | CSE | 29 ± 3 | 68.4 ± 6.3 | 157 ± 6.5 | Hypotension (SBP less than 90 mm Hg or a 30% decrease from baseline level) |
| 20 | 5.0 mg bupivacaine | 28 ± 4 | 67.7 ± 5.8 | 159 ± 7.2 | ||||
| 20 | 7.5 mg bupivacaine | 28 ± 3 | 69.7 ± 6.3 | 157 ± 6.9 | ||||
| 20 | 10.0 mg bupivacaine | 27 ± 4 | 67.5 ± 5.8 | 157 ± 7.2 | ||||
| Pedersen H (21) | 1989 | 17 | 7.5–10 mg bupivacaine | S | 30.1 ± 1.2 | 78.2 ± 3.1 | 160 ± 1.8 | Hypotension (SBP below 100 mm Hg), introoperative analgesia (0–10 cm VAS) |
| 19 | 10–12.5 mg bupivacaine | 31.6 ± 1.1 | 78.2 ± 3.1 | 160 ± 1.5 |
S, spinal anesthesia; CSE, combined spinal‐anesthesia; VAS, visual analog scale; MBP, mean blood pressure; SAP, systolic arterial pressure; SBP, systolic blood pressure.
athe blood pressure at which vasopressor drugs were given was taken as definition.
bexcellent: no discomfort during the surgical procedure; good: mild discomfort but no systemic analgesics supplementation given; fair: pain that need additional analgesic supplementation; poor: moderate or severe pain that need ketamine more than 100 mg [Ref. 12] or fentanyl 100 μg [Ref. 19] or general anesthesia.
cvalues are mean (range), the others are mean ± SD.