Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine?

Abstract

We have evaluated the influence of speed of intrathecal injection on lateral distribution of 0.5% hyperbaric bupivacaine. We studied 60 patients undergoing lower limb surgery who were placed in the lateral position with the operative side in the dependent position. After dural puncture (25-gauge Whitacre spinal needle), the needle aperture was turned towards the dependent side and 0.5% hyperbaric bupivacaine 8 mg was injected randomly at a rate of 0.02 ml s-1 (group slow, n = 30) or 0.25 ml s-1 (group fast, n = 30). Lateral position was maintained for 15 min while a blinded observer recorded loss of pinprick sensation and degree of motor block on both surgical and non-surgical sides. There were no differences between the groups. Forty-five minutes after patients were turned to the supine position, spinal anaesthesia was unilateral in 17 patients in group slow (56%) and in 13 patients in group fast (43%). We conclude that using extremely low speeds for intrathecal injection were not clinically advantageous in obtaining unilateral spinal anaesthesia.

Baixas doses de bupivacaína hipobárica para raquianestesia unilateral

“…Pencil point needles and slow injections are factors related to transient neurological symptoms, especially with hyperbaric lidocaine 27 . No transient neurological symptoms were observed in this study with cutting point needles and hypobaric bupivacaine, which is in line with other authors 4,28 who have evaluated the influence of 0.5% hyperbaric bupivacaine injection speed in lateral distribution. Cutting point needles course with low headache incidence 20 , what was confirmed by our study with no CSF removal (no headache observed) and similar to a previous study with 3 to 5 ml CSF removal 2 .…”

“…Com soluções hipobáricas, a incidência de raquianestesia unilateral varia de 43% 27 . Usando agulha ponta cortante e bupivacaína hipobári-ca nenhum caso de sintomas neurológicos transitórios foi observado neste estudo, que está de acordo com outros autores 4,28 que avaliaram a influência da velocidade da injeção de bupivacaína hiperbárica a 0,5% em distribuição lateral. A agulha ponta cortante cursa com uma baixa incidência de cefaléia 20 , fato confirmado neste estudo sem retirada de LCR, onde não ocorreu nenhum caso de cefaléia, da mesma forma em estudo anterior com retirada de 3 a 5 ml 2 .…”

Influence of injection rate of hyperbaric bupivacaine on spinal block in parturients: a randomized trial

“…Several studies have demonstrated more extensive spread with faster injection [5][6][7][8] while others report either greater spread with slower injection, [9][10][11][12][13] or no difference. [14][15][16][17][18] Slow injection of hyperbaric bupivacaine 10 mg over 60 and 120 sec has been shown to reduce the incidence and severity of hypotension during Cesarean delivery under spinal anesthesia. 19,20 Varying results from the many studies may be attributable to incomplete control of potential confounding variables and other methodogical limitations.…”

Düşük Doz Spinal Anestezi ile Varis Operasyonu

“…In studies using hyperbaric bupivacaine, it was advised to give lateral position to the patient on the operation side approximately for 10-20 minutes to establish efficient unilateral spinal block (18,19). 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.…”

“…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).…”