Effect of a 20% Reduction in Hyperbaric Bupivacaine Dose on High Spinal Block Incidence in Cesarean Delivery: A Risk-Stratified Randomized Controlled Trial.

This an interventional study comparing effect of Standard dose of Hyperbaric bupivacaine with 20% reduction of dose of Hyperbaric Bupivacaine in Elective Cesarean Delivery.

First, we determaine if the patient ( low - moderate - high ) risk to High spinal complication or not according to : Age-weight-BMI-Height.

Then , Randomly we gave the patients " Full dose of Hyperbaric Bupivacaine OR 20% reduction of hyperbric Bupivacaine " in spinal anaethsia .

Post anesthesia evaluation:

to assess incomplete sensory and/or motor blockade after spinal anesthesia for cesarean section is the Bromage Scale for motor blockade and a sensory block assessment using pinprick or cold sensation.

• Bromage Scale for Motor Blockade:

This scale assesses the degree of motor block in the lower limbs:

• Grade 0: No paralysis, full flexion of knees and feet.
• Grade 1: Inability to raise extended legs; can move knees and feet.
• Grade 2: Inability to flex knees; can move feet.
• Grade 3: Complete paralysis of the lower limbs.

Incomplete motor blockade would typically be Bromage 1 or 2.

• Sensory Block Assessment:

• Sensory block is often assessed using a pinprick test or cold sensation (ice or alcohol swab).
• Levels are recorded using dermatome levels (T10, T6, T4, etc.).
• Incomplete sensory block means failure to achieve adequate sensory block (T4-T6 for cesarean section), requiring additional analgesia or conversion to general anesthesia.

Inclusion criteria

• • Pregnant women aged 18-45 years.

• ASA physical status II-III.

Exclusion criteria

• • Twin pregnancies.

• Contraindications to spinal anesthesia (e.g., coagulopathy, infection).
• Patients with incomplete preoperative data for risk stratification.