Dose Response Study of Bupivacaine in Spinal Anesthesia

Sheskey, Michael C.; Rocco, Angelo G.; Bizzarri-Schmid,; Covino, Benjamín G.

doi:10.1097/00000542-198209001-00198

Cited by 26 publications

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“…Most of the studies suggest that the total dosage is more important than the volume [7][8][9]. In these studies, the doses of bupivacaine were fairly large.…”

Section: Discussionmentioning

confidence: 99%

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Low‐dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee

et al. 1999

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SummaryThe results of studies on the effect of volume, concentration or total dose of local anaesthetic on the spread of spinal anaesthesia are inconclusive. Most support the assumption that the total dosage is more important than the volume. We compared low-dose bupivacaine (6 mg) in 0.5% and 0.18% solutions as sole anaesthetic to achieve predominantly unilateral spinal anaesthesia for knee arthroscopy. Sixty patients were randomly allocated to two groups to receive either 1.2 ml 0.5% bupivacaine (6 mg) (n ¼ 30) or 3.4 ml 0.18% hypobaric bupivacaine (6.1 mg) (n ¼ 30). Drugs were administered at the L 3-4 interspace with the patient in the lateral position. Patients remained in this position for 20 min before being turned supine for the operation. Spinal block was assessed by pinprick and modified Bromage scale and compared between the operated and nonoperated sides. No significant changes were found in the spread or duration of sensory or motor block (p > 0.05). The haemodynamic changes were also similar between the groups. The same pinprick level of analgesia, degree of motor block and duration of spinal anaesthesia was obtained with bupivacaine (6 mg) in low (1.2 ml) or high (3.4 ml) volumes. The ideal spinal anaesthesia for ambulatory surgery should provide good surgical anaesthesia with rapid recovery from sensory and motor block [1]. Lignocaine has been widely advocated for ambulatory anaesthesia but there are concerns about possible neurotoxicity. Recent editorials have questioned the use of hyperbaric 5% lignocaine for spinal anaesthesia [2][3][4]. In contrast, the frequency of radiating backache after bupivacaine has been reported as less than 1% [5,6]. There is increasing interest in the use of small doses of bupivacaine for spinal anaesthesia.There has been controversy concerning the relationship between volume, concentration and total dose of spinally administered drugs. Most of the studies suggest that the total dosage is more important than the volume [7][8][9]. In these studies, the doses of bupivacaine were fairly large. Sheskey et al. used 10, 15 and 20 mg doses [7] and Bengtsson et al. used bupivacaine 22.5 mg [8]. In the study of Cherng et al., plain bupivacaine 15 mg was diluted with cerebrospinal fluid (CSF) [9]. The effect of volume on spinal anaesthesia when a small dose (5-10 mg) of hypobaric bupivacaine is used has not been investigated.In a previous study, we achieved predominantly unilateral spinal anaesthesia with minimal sensory and motor block on the nonoperated side using a low dose of hypobaric 0.18% bupivacaine [10]. We have now compared low-dose bupivacaine (6 mg) in two volumes for predominantly unilateral spinal anaesthesia for day-case knee arthroscopy. Methods

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“…Most of the studies suggest that the total dosage is more important than the volume [7][8][9]. In these studies, the doses of bupivacaine were fairly large.…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, the doses of bupivacaine were fairly large. Sheskey et al used 10, 15 and 20 mg doses [7] and Bengtsson et al used bupivacaine 22.5 mg [8]. In the study of Cherng et al, plain bupivacaine 15 mg was diluted with cerebrospinal fluid (CSF) [9].…”

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confidence: 99%

Low‐dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee

et al. 1999

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“…Características do paciente como idade, altura e peso afetam a dispersão de anestésico local dentro do espaço subaracnóideo. A bupivacaína isobárica estudada em diferentes grupos de idade tem mostrado uma dispersão variável 12,13 . Entretanto, outros trabalhos, utilizando 3 ml em pacientes de 15 a 92 anos 14 e 4 ml de 33 a 97 anos 15 , apresentam uma correlação entre a extensão do bloqueio sensitivo e o aumento da idade.…”

Section: Introductionunclassified

“…Age, height and weight, interfere with local anesthetic spread in the intrathecal space. Isobaric bupivacaine has shown variable spread in different age groups 12,13 . A correlation between sensory block level and age was observed in patients aging from 15 to 92 years treated with 3 ml 14 , and in patients aging from 33 to 97 years 15 treated with 4 ml of 0.5% isobaric bupivacaine.…”

Section: Introductionmentioning

confidence: 99%

Raquianestesia com lidocaína a 2% pura em cirurgias ortopédicas de curta duração: estudo em 250 pacientes

Imbelloni¹

2002

Rev. Bras. Anestesiol.

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“…Instead, the results should be evaluated separately. We believe that the dose of local anesthetic and the position of the patient are the two major factors in understanding why there are differences in the results of the two studies [3].…”

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confidence: 99%

Answer to the letter to the editor of Monica del-Rio-Vellosillo et al. entitled “A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery” by Sahin AS, Türker G, Bekar A, Bilgin H, Korfalı G (2013). Eur Spine J 9. doi:10.1007/s00586-013-3082-0

Şahin

2014

Eur Spine J

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Dose Response Study of Bupivacaine in Spinal Anesthesia

Cited by 26 publications

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Low‐dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee

Low‐dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee

Raquianestesia com lidocaína a 2% pura em cirurgias ortopédicas de curta duração: estudo em 250 pacientes

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