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Canadian Journal of Anaesthesia

, Volume 45, Issue 9, pp 850–854 | Cite as

Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia

  • Andrea Casati
  • Guido Fanelli
  • Gianluca Cappelleri
  • Battista Borghi
  • Valeria Cedrati
  • Giorgio Torri
Reports of Investigation

Abstract

Purpose

To evaluate the effects of hyperbaric bupivacaine concentration in producing unilateral spinal anaesthesia.

Methods

With Ethical Committee approval and written consent, 60 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent. After durai puncture (25-gauge Whitacre spinal needle), the needle hole was turned toward the dependent side and patients were randomly assigned to receive 8 mg of either 0.5% (Group05%, n = 30) or 1% (Group1%, n = 30) hyperbaric bupivacaine. The lateral position was maintained for 15 min, while a blinded observer recorded loss of pinprick sensation and degree of motor block on both sides until two segment regression of sensory level on the dependent side.

Results

At the end of the 15 min lateral position spinal anaesthesia was more frequently unilateral in Group0.5% (80%) than in Group1%(53%)(P < 0.05). However, 30 min after patients were turned supine, unilateral spinal anaesthesia decreased to 60% of cases in Group0.5% and 40% of cases in Group1%(P = NS). The maximum sensory level on the dependent side [T10(L1 − T2) in Group0.5% and T8 (T12 − T3) in Group1%], time to reach it [20 (5–30) min in Group0.5% and 25 (10–35) min in Group1%], and time to two segment regression of sensory level [80 (30–135) min in Group0.5% and 75 (20–135) min in Group1%] were similar in both groups.

Conclusion

Highly concentrated solutions of hyperbaric bupivacaine are not advantageous in obtaining a unilateral spinal anaesthesia, when a small anaesthetic dose is injected slowly through a Whitacre spinal needle.

Keywords

Bupivacaine Sensory Level Motor Block Dural Puncture Spinal Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Évaluer les effets de la concentration de bupivacaïne hyperbare dans la production d’une rachianesthésie unilatérale.

Méthode

Après avoir reçu l’approbation du Comité d’éthique et une autorisation écrite, 60 patients devant subir une chirurgie du membre inférieur ont été placés en position latérale, le site opératoire du côté déclive. Après la ponction de la dure-mère (aiguille rachidienne Whitacre de calibre 25), la perforation latérale de l’aiguille a été orientée vers le côté déclive et les patients ont été répartis au hasard afin de recevoir 8 mg de bupivacaïne hyperbare 0,5% (Groupe0.5%, n = 30) ou 1% (Groupe1% n = 30) La position latérale a été maintenue pendant 15 min pendant lesquelles un observateur impartial a enregistré la perte de sensation de piqûre et le degré de blocage moteur des deux côtés jusqu’à une régression de deux segments du niveau sensitif sur le côté déclive.

Résultats

Après ces 15 min en position latérale, la rachianesthésie était plus souvent unilatérale dans le Groupe0,5% (80 %) que dans le Groupe1%(53 %) (P < 0,05). Cependant, 30 minutes après que les patients ont été tournés en décubitus dorsal, la rachianesthésie unilatérale a diminué à 60 % dans le Groupe0,5% et à 40 % dans le Groupe1% (P = NS). Ont été similaires dans les deux groupes: le niveau sensitif maximal du côté déclive [T10 (L1-T2) dans le Groupe0,5% et T8 (T12-T3) dans le Groupe1%], le temps requis pour atteindre ce niveau [20 (5–30) min dans le Groupe0,5% et 25 (10–35) min dans le Groupe1%] et le temps pour que se produise une régression de deux segments du niveau sensitif [80 (30–135) min dans le Groupe0,5% et 75 (20–135) min dans le Groupe1%].

Conclusion

Des solutions très concentrées de bupivacaine hyperbare ne sont pas avantageuses pour obtenir une rachianesthésie unilatérale lorsqu’une faible dose d’anesthésique est injectée lentement au moyen d’une aiguille rachidienne Whitacre.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  • Andrea Casati
    • 1
  • Guido Fanelli
    • 1
  • Gianluca Cappelleri
    • 1
  • Battista Borghi
    • 1
    • 2
  • Valeria Cedrati
    • 1
  • Giorgio Torri
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care, IRCCS H San RaffaeleUniversity of MilanMilanItaly
  2. 2.Department of AnaesthesiaIstituti Ortopedia RizzoliBolognaItaly

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