Obstetric Characteristics and Anesthetic Satisfaction Following Neuraxial Blockade with 0.5% Hyperbaric Bupivacaine in Women Undergoing Cesarean Section in Southwest Mexico

Abstract

Background: Cesarean section is indicated in conditions that increase the risk of maternal and perinatal morbidity and mortality. The anesthetic technique of neuraxial block with 0.5% hyperbaric bupivacaine is widely used in Mexico. However, the level of perceived satisfaction with this technique has been little studied in the Southwest Region, despite the region's high population of women of childbearing age, frequency of risk factors, and birth rate. The findings of our research will indicate the demographic and obstetric conditions, hemodynamic behavior during the procedure, and level of anesthetic satisfaction, generating essential information to improve the quality of care and optimize institutional resources. Aim: To know obstetric characteristics and anesthetic satisfaction following neuraxial blockade with 0.5% hyperbaric bupivacaine in women undergoing cesarean section in Southwest Mexico. Methods: Prospective and descriptive study [ethical approval folio: R-2024-703-076] in women aged 18-39 years with a gestational age 37-40 weeks who underwent cesarean section at a Level II Public Hospital in Southwest Mexico during October–November 2024. Patients with serious complications or who were referred to other medical units were excluded. During pre-anesthetic evaluation, demographic data [maternal age, body mass index (BMI)], obstetric data [pregnancies, deliveries, cesarean sections, abortions, gestational age at delivery] and anesthetic risk [American Society of Anesthesiologists Physical Status Classification System (ASA)] were collected. Hemodynamic status was assessed at start procedure. The Iowa Satisfaction with Anesthesia Scale [ISAS] was administered in the post-anesthesia care unit 15 minutes after admission. Pain intensity [Visual Analogue Scale (VAS)] was assessed during hospitalization. Descriptive statistics were used with Statistical Package for Social Sciences (SPSS) version 25. Results: The study included 289 women. The maternal age was 26.0±4.1 years and BMI was 34.9±5.9 kg/m². Patients with >3 pregnancies and >2 cesarean sections represented 10.4% and 5.5%. ASA classification II was recorded for all patients. The gestational age at delivery was 37.2±2.2 weeks. Significant hemodynamic changes were observed at beginning the procedure. The overall satisfaction level was 2.9 ± 0.1; 57.4% reporting very satisfaction and 42.2% moderate satisfaction. The VAS values at 2, 4 and 8 hours after procedure were 3.9±1.2; 5.6±1.8; and 5.3±1.2. Conclusion: The women in southwestern Mexico who underwent cesarean section were primarily between 18-35 years old, obese, and had a gestational age ≥37 weeks. A history of high-risk obstetrics was common. Hemodynamic instability was observed at beginning the procedure. Anesthetic satisfaction was mainly reported as very satisfied or moderately satisfied. Moderate pain intensity was most prevalent. The effectiveness of 0.5% hyperbaric bupivacaine neuraxial blockade in cesarean section is noteworthy. However, it is essential to continue searching for safe and effective anesthetic alternatives for this priority group to provide higher quality care and optimize institutional resources.