Home‐readiness after spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine

Abstract

SummaryFifty-four patients were studied prospectively to evaluate home-readiness after a small dose (1 or 2 ml) of subarachnoid hyperbaric 0.5% bupivacaine. The block regressed significantly earlier in the 1 ml group than in the 2 ml group (p < 0.05). The patients were also able to walk significantly earlier in the 1 ml group (median 161 min and 231 min in the 1 ml and 2 ml groups, respectively) (p < 0.05). However, there were no significant differences between the groups in time of ability to void. We conclude that adequate surgical anaesthesia can be achieved with small doses of hyperbaric bupivacaine used for spinal anaesthesia. Although the sensory and motor block after 1 or 2 ml hyperbaric bupivacaine recovered within a reasonable time for day-case surgery, in some patients recovery of the ability to void was delayed to an undesirable extent. [6][7][8]. The use of bupivacaine in spinal anaesthesia is rarely followed by transient neurological symptoms [9]. We therefore studied prospectively the quality of spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine and paid special attention to patients' home-readiness following the block. Patients and methodsFifty-four ASA I or II patients scheduled for procedures with expected duration less than 1 h (minor orthopaedic, urology or anal surgery) gave their informed consent to participate in the study. The study was approved by the Ethics Committee of the hospital. Obese patients (body mass index greater than 30) or patients with pulmonary or cardiac disease were not studied.The patients were premedicated with diazepam 0.2 mg. kg ¹1 orally 60 min before arrival in the operating theatre.

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

“…The mean time to first passing urine was longer than the mean time to the complete resolution of the motor and sensory block. This is in accordance with the studies of Ben-David et al [19] and Tarkkila et al [21] whose subjects were able to walk before they could micturate. Our patients were advised not to attempt to pass urine before they had a natural urge to do so.…”

“…The total motor block score (modified Bromage scale; mean Ϯ SD) on the operated and nonoperated sides in patients receiving near isobaric (group 1; n ¼ 30) and hypobaric (group 2; n ¼ 30) bupivacaine (6 mg) for spinal anaesthesia. reported after hyperbaric bupivacaine spinal anaesthesia [5,21]. In our present study, there was no evidence of transient neurological sequelae.…”

“…Although spinal anaesthesia can be achieved with hypo-and hyperbaric solutions of bupivacaine [10,[18][19][20][21], transient neurological symptoms have been Anaesthesia, 1999, 54, pages 540-545 K. S. Kuusniem et al…”

The Comparison of Hypertonic Saline (7.5%) and Normal Saline (0.9%) for Initial Fluid Administration Before Spinal Anesthesia

“…Hyperbaric bupivacaine 0.5% in a dose of 10 mg was chosen for spinal anesthesia because it provides tolerance to pneumatic tourniquet for 70 min (21), which is usually enough for arthroscopic anterior cruciate ligament-reconstruction and other orthopedic lower limb surgery. This dose may, however, delay the ability to void in some patients (22). In our study, the time of the first micturition in both groups was comparable to previous results (22), despite the much smaller amount of infused free water in the HS group.…”

“…This dose may, however, delay the ability to void in some patients (22). In our study, the time of the first micturition in both groups was comparable to previous results (22), despite the much smaller amount of infused free water in the HS group. In addition to the ability to maintain adequate MAP, HS solution improves kidney function by reducing renal vascular resistance (23).…”