Frequency of Hypotension During Conventional or Asymmetric Hyperbaric Spinal Block

Casati, Andrea; Fanelli, Guido; Aldegheri, Giorgio; Colnaghi, Eleonora; Casaletti, Elisabetta; Cedrati, Valeria; Torri, G.

doi:10.1097/00115550-199924030-00006

Cited by 44 publications

(67 citation statements)

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“…15 Optimally titrated unilateral spinal anesthetic can reduce the incidence of intraoperative hypotension to within 5% of cases. 16 Lowdose spinal anesthesia also reduces the incidence of urinary retention and improves early mobilization and rehabilitation. Several studies have examined the impact of different doses of local anesthetics on regional block characteristics, micturation problems, and discharge time for patients receiving spinal anesthesia.…”

Section: Résumémentioning

confidence: 99%

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

Awad

Cheung

Al-Allaq

et al. 2012

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

Awad

Cheung

Al-Allaq

et al. 2012

Can J Anesth/J Can Anesth

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“…4,6,7 Also directional pencil point needles 8 have been advocated for short procedures involving only one lower limb 4,6,7 to minimize the cardiovascular effects of spinal block. 9,10 However, no randomized studies have been reported to evaluate the efficacy, latency of surgical block, and patient discharge of either unilateral or conventional bilateral spinal anesthesia performed with the same dose of hyperbaric bupivacaine.…”

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confidence: 99%

Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy

Fanelli

Borghi

Casati

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare unilateral and conventional bilateral bupivacaine spinal block in outpatients undergoing knee arthroscopy.Methods: One hundred healthy, premedicated patients randomly received conventional bilateral (n = 50) or unilateral (n = 50) spinal anesthesia with 8 mg hyperbaric bupivacaine 0.5%. A lateral decubitus position after spinal injection was maintained in unilateral group for 15 min. Times from spinal injection to readiness for surgery, block resolution, and home discharge were recorded.Results: Three patients in each group were excluded due to failed block. Readiness for surgery required 13 min (5 -25 min) with bilateral and 16 min (15 -30) with unilateral spinal block (P = 0.0005). Sensory and motor blocks on the operated limb were T 9 (T 12 -T 2 ) with a Bromage score 0/1/2/3: 0/2/0/45 in the unilateral group and T 7 (T 12 -T 1 ) with Bromage score 0/1/2/3: 4/1/6/36 with bilateral block (P = 0.026 and P= 0.016, respectively). Vasopressor was required only in five bilateral patients (P = 0.02). Two segment regression of sensory level and home discharge required 81 ± 25 min and 281 ± 83 min with bilateral block, and 99 ± 28 min and 264 ± 95 min with unilateral block (P = 0.002 and P = 0.90, respectively). Conclusion:Seeking unilateral distribution of spinal anesthesia provided more profound and longer lasting block in the operated limb, less cardiovascular effects, and similar home discharge compared with bilateral spinal anesthesia, with only a slight delay in preparation time.Objectif : Comparer le bloc rachidien unilatéral au bloc bilatéral traditionnel chez des patients ambulatoires qui subissent une arthroscopie du genou.Méthode : Cent patients sains ont reçu une prémédication et, de façon aléatoire, une rachianesthésie bilatérale traditionnelle (n = 50) ou unilatérale (n = 50) avec 8 mg de bupivacaïne hyperbare à 0,5 %. Après l'injection, les patients du groupe unilatéral ont été maintenus en décubitus latéral pendant 15 min. On a enregistré : le temps écoulé entre l'injection et le début de l'opération, le temps nécessaire à la résolution du bloc et le moment de la sortie du service.Résultats : Trois patients ont été exclus dans chaque groupe à cause de l'échec du bloc. Il a fallu 13 min (5 -25 min) de préparation à l'opération avec le bloc bilatéral et 16 min (15 -30) avec le bloc unilatéral (P = 0,0005). Les blocs sensitif et moteur sur le membre opéré ont été de T 9 (T 12 -T 2 ) avec des scores de 0/1/2/3: 0/2/0/45 à l'échelle de Bromage dans le groupe unilatéral et de T 7 (T 12 -T 1 ) et des scores de Bromage de 0/1/2/3: 4/1/6/36 avec le bloc bilatéral (P = 0,026 et P = 0,016, respectivement). Des vasopresseurs ont été nécessaires chez cinq patients seulement du groupe bilatéral (P = 0,02). Le temps nécessaire à la régression de deux segments du bloc sensitif et au congé a été de 81 ± 25 min et de 281 ± 83 min avec le bloc bilatéral, et de 99 ± 28 min et 264 ± 95 min avec le bloc unilatéral (P = 0,002 et P = 0,90, respectivement).Conclusion : La rachianesthésie unilatérale, compar...

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“…The unilateral blockade with either one of the three solutions causes less hypotension. When hemodynamic changes secondary to unilateral and bilateral blockade with the same dose of hyperbaric bupivacaine (8 mg) are compared, the frequency of hypotension are 22.4% and 5%, respectively 26 . With 7.5 mg of bupivaciane, hypotension was observed in 1/25 patients in the Hyper Group, and 1/25 patients in the Hypo Group, although prophylactic vasopressor or intravenous infusion were not administered 24 .…”

Section: Discussionmentioning

confidence: 99%

Baixa dose de bupivacaína isobárica, hiperbárica ou hipobárica para raquianestesia unilateral

Imbelloni

Beato²,

Gouveia

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A raquianestesia unilateral pode apresentar vantagens principalmente em pacientes em regime ambulatorial. Baixa dose da solução anestésica, velocidade lenta da injeção espinal e a posição lateral facilitam a obtenção da distribuição unilateral na raquianestesia. Foram comparadas soluções isobárica, hiperbárica e hipobárica de bupivacaína com objetivos de se obter raquianestesia unilateral em pacientes submetidos a intervenções cirúrgicas ortopédicas em regime ambulatorial. MÉTODO:Cento e cinqüenta pacientes foram aleatoriamente separados em três grupos para receberem 5 mg de bupivacaína a 0,5% isobárica (Grupo Iso), ou 5 mg de bupivacaína a 0,5% hiperbárica (Grupo Hiper), ou 5 mg de bupivacaína a 0,15% hipobárica (Grupo Hipo). As soluções foram administradas no interespaço L 3 -L 4 com o paciente na posição lateral e permanecendo nesta posição por 20 minutos. A anestesia sensitiva foi avaliada pelo teste da picada da agulha. O bloqueio motor avaliado pela escala modificada de Bromage. Ambos os bloqueios foram comparados com o lado não operado e entre si. RESULTADOS:Existiu diferença significativa entre o lado operado e não-operado em todos os três grupos aos 20 minutos, mas maior freqüência de raquianestesia unilateral foi obtida com as soluções hiperbárica e hipobárica de bupivacaína. Bloqueio sensitivo e motor foram observados em 14 pacientes do Grupo Iso, 38 pacientes no Grupo Hiper e 40 pacientes no Grupo Hipo. Não ocorreram alterações hemodinâmicas em nenhum paciente. Não foram observados cefaléia pós-punção nem sintomas neurológicos temporários. CONCLUSÕES:A raquianestesia com soluções hipobárica e hiperbárica proporcionou maior freqüência de unilateralidade. Após 20 minutos a solução isobárica de bupivacaína mobilizou-se no lí-quido cefalorraquidano (LCR), resultando em apenas 28% de raquianestesia unilateral.Unitermos: ANESTÉSICOS: bupivacaína; CIRURGIA, Ortopédica; TÉCNICAS ANESTÉSICAS, Regional: raquianestesia unilateral. SUMMARYImbelloni LE, Beato L, Gouveia MA, Cordeiro JA -Low Dose Isobaric, Hyperbaric, or Hypobaric Bupivacaine for Unilateral Spinal Anesthesia. BACKGROUND AND OBJECTIVES:Unilateral spinal anesthesia has its advantages, especially in patients undergoing outpatient basis surgeries. Low dose, slow speed of administration, and the lateral positioning make easier the unilateral distribution in spinal anesthesia. Isobaric, hyperbaric, and hypobaric solutions of bupivacaine were compared in the unilateral spinal anesthesia in patients undergoing outpatient basis orthopedic surgeries. METHODS:One hundred and fifty patients were randomly divided in three groups to receive 5 mg of 0.5% isobaric bupivacaine (Iso Group), 5 mg of 0.5% hyperbaric bupivacaine (Hyper Group), or 5 mg of 0.15% hypobaric bupivacaine (Hypo Group). The solutions were administered in the L 3 -L 4 space with the patient in the lateral decubitus and remaining in this position for 20 minutes. Sensitive anesthesia was evaluated by the pin prick test. Motor blockade was determined by the modified Brom...

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Frequency of Hypotension During Conventional or Asymmetric Hyperbaric Spinal Block

Cited by 44 publications

References 0 publications

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

Low-dose spinal bupivacaine for total knee arthroplasty facilitates recovery room discharge: a randomized controlled trial

Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy

Baixa dose de bupivacaína isobárica, hiperbárica ou hipobárica para raquianestesia unilateral

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