hello,

I think many factors are contributing to dosing of local anesthetic in c-section. the patient first of all should be comfortable with a block reaching T4. At the same time measures to prevent high spinal should be attempted; patient positioning, crystalloids preloading or/and prophylactic dose of ephedrine.

I personally found that there is alot of patient to patient response variation. the standard dosing of 8-12 mg of bupivacain seems to be associated with higher incidence of high spinal in our population "Bahrain". Parturents here seem to be more sensitive. I am not sure if it is related to hight, because most of patients hights range from 150-170 cm.

I've never had to use more than 10mg bupivacaine even for the tallest.

good luck

buthayna