Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection

Apaydın, Yılmaz; Erk, Gülcan; Saçan, Özlem; Tiryaki, Civan; Taspinar, Vildan

doi:10.1007/s00540-011-1111-x

Cited by 11 publications

(12 citation statements)

References 20 publications

(27 reference statements)

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“…In this study we achieved a success rate of 98% in achieving a unilateral spinal block, which is greater than the success rates of 13% to 94% described in other studies [6][7][8][9]12,13,[18][19][20] . The wide range of success reported probably reflects the lack of a standardised procedure for performing the spinal block.…”

Section: Discussioncontrasting

confidence: 54%

“…Of these, the injection rate appears to be the most important factor. Two studies directly compared the effect of different injection rates and found better success achieving a unilateral effect with a slower injection 12,13 . With an injection rate of 0.5 ml/min, which is 33% faster than that used in this study, the success rates were 48% 12 and 94% 13 .…”

Section: Discussionmentioning

confidence: 99%

“…We used these changes in skin resistance to titrate the dose of the local anaesthetic. Skin temperature is also indirectly influenced by sympathetic blockade and, although it responds more slowly and less reliably than electrical dermal resistance, some researchers have employed it as a target parameter 7,12,13 .…”

mentioning

confidence: 99%

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Selective Unilateral Spinal Anaesthesia for Outpatient Knee Arthroscopy Using Real-Time Monitoring of Lower Limb Sympathetic Tone

Bergmann

et al. 2015

Anaesth Intensive Care

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Selective unilateral spinal anaesthesia is a useful approach for ambulatory lower limb surgery because it allows more rapid home discharge compared to bilateral block. Infrequent use is due to the fact that obtaining selective unilateral block can be difficult, requiring attention to technique. We present a method with a high success rate that uses real-time monitoring of the sympathetic activity of the legs. In this prospective study, 56 patients scheduled for ambulatory knee arthroscopy had spinal anaesthesia in the lateral recumbent position, with hyperbaric bupivacaine 0.5% injected at 0.33 ml/min up to a maximum dose of 5 mg. Sympathetic tone of the legs was monitored by plantar electrical dermal resistance. The clinical effect was assessed by loss of sensation and muscle strength. The haemodynamic course and adverse events were monitored. The motor block was strictly unilateral in 55 patients (98%) and the sensory block was strictly unilateral in 53 patients (94%). The median decrease in systolic blood pressure was 6 mmHg. The time from subarachnoid puncture to arrival in the recovery room was 73 ± 23 minutes; the duration of stay in the recovery room was 70 ± 30 minutes. Three patients with a well-established block of adequate extent required conversion to general anaesthesia because of tourniquet pain. Urinary retention only occurred in the sole patient with bilateral block. This method of performing selective unilateral spinal anaesthesia using real-time monitoring of sympathetic tone of the legs has a high success rate and is associated with rapid eligibility for home discharge.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Selective Unilateral Spinal Anaesthesia for Outpatient Knee Arthroscopy Using Real-Time Monitoring of Lower Limb Sympathetic Tone

Bergmann

et al. 2015

Anaesth Intensive Care

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“…However, after use of hyperbaric anesthetics the incidence of hypotension is as much as 60–90% during the perioperative period [ 9 – 15 ]. This is related to both the rapid onset of analgesia in spinal anesthesia and the characteristics of hyperbaric anesthetics, such as the uncontrolled upper plane of anesthesia [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

et al. 2015

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PurposeTo observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study.MethodsParturients (n = 136) undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A) or hyperbaric ropivacaine (Group B). Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis.ResultsGroup A had a lower level of sensory blockade (T6 [T6-T7]) and longer time to achieve T8 sensory blockade level (8 ± 1.3 min) than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P < 0.001, both). The incidence rates for hypotension, nausea, and vomiting were significantly lower in Group A (13%, 10%, and 3%, respectively) than Group B (66%, 31%, and 13%; P < 0.001, P = 0.003, P = 0.028).ConclusionsCombined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade.Trial RegistrationChinese Clinical Trial Register ChiCTR-TRC-13004622

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“…In our study, the patients were turned to lateral position on the operation side for 15 minutes and intratechal injection time was about 40 seconds. The effect of different speeds of intrathecal injection on the unilateral spinal block formation is controversial (19,20).…”

Section: Discussionmentioning

confidence: 99%

Düşük Doz Spinal Anestezi ile Varis Operasyonu

Muhammedoğlu¹,

Başaranoğlu²,

Teker³

et al. 2014

Haseki

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Abs tractAim: Spinal anesthesia is frequently used for procedures involving the lower limbs. Compared with general anesthesia, low-dose spinal anesthesia is a cost-effective method and has advantages such as avoiding hypotension, longer duration of anesthesia and increased length of hospitalization. The aim of this trial was to compare two different low-dose bupivacaine drug regimens. Methods: Sixty unpremedicated patients were randomly allocated into two groups (n=30). There were no differences between the groups in age, weight, the American Society of Anesthesiologists (ASA) physical status classification, gender, and duration of surgery. We performed spinal anesthesia at the L3-4 interspace with the patient in the lateral decubitus position. We administered 6.5 mg (group 1) and 8 mg (group 2) 0.5% heavy bupivacaine into the subarachnoid space. We positioned the patient laterally to the operation side for 15 minutes, then, turned to supine position. Motor and sensory block was assessed by the Bromage scale and pinprick test. Results: There were significant differences between the two groups in duration of motor block, but no significant differences in hemodynamic response to spinal anesthesia. None of the patients had intraoperative pain. Five patients in group 1 and 2 patients in group 2 had urinary retention. Conclusion ÖzetAmaç: Spinal anestezi sıklıkla alt ekstremite operasyonları için kullanılmaktadır. Düşük doz spinal anestezi genel anesteziye göre daha ekonomik bir metot olup, hipotansiyon, anestezinin uzun sürmesi, hastanede uzun süreli yatış gibi durumlardan kaçınılması gibi avantajlara sahiptir. Bu çalışmanın amacı 2 farklı düşük doz bupivakaini karşılaştırmaktır.Yöntemler: Premedikasyon yapılmamış 60 hasta randomize olarak 2 gruba ayrıldı. Gruplar arasında yaş, ağırlık, ASA grubu, cinsiyet, ameliyat süreleri bakımından farklılık yoktu. Spinal anestezi L3-L4 aralığından lateral dekübit pozisyonda yapıldı. Grup 1'e 6.5 mg, grup 2'ye 8 mg %0.5 ağır bupivakain subaraknoid aralıktan verildi. Hastalar operasyon yapılacak tarafta 15 dakika bekletildikten sonra sırtüstü pozisyona çevrildi. Motor blok Bromage, duysal blok Pinprick testi ile değerlendirildi. Bulgular: İki grup arasında motor blok açısından anlamlı farklılık varken, spinal anesteziye hemodinamik cevap açısından anlamlı bir farklılık yoktu. Hiçbir hastada intraoperatif ağrı olmadı. Grup 1'de 5 hastada, Grup 2'de 2 hastada üriner retansiyon gelişti. Sonuç

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Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection

Cited by 11 publications

References 20 publications

Selective Unilateral Spinal Anaesthesia for Outpatient Knee Arthroscopy Using Real-Time Monitoring of Lower Limb Sympathetic Tone

Selective Unilateral Spinal Anaesthesia for Outpatient Knee Arthroscopy Using Real-Time Monitoring of Lower Limb Sympathetic Tone

Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

Düşük Doz Spinal Anestezi ile Varis Operasyonu

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