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

Abstract

Purpose: A prospective, randomized, double-blind clinical trial was undertaken to determine whether a tenfold difference in the rate of intrathecal injection of bupivacaine would affect sensory block level in parturients. Secondary outcomes included onset of block and the incidence of hypotension and nausea. Methods:Following Research Ethics Board approval, 90 ASA I and II term parturients scheduled for Cesarean delivery were randomized to receive either fast injection (over four seconds, Group F) or slow injection (over 40 sec, Group S) of 0.75% hyperbaric bupivacaine 12 mg plus morphine 200 µg. Sensory block, motor block, and blood pressure were assessed every minute for the first 15 min, then every five minutes for the next 20 min. All occurrences of nausea, hypotension (decrease in systolic blood pressure > 30%) and ephedrine requirements were recorded. Results:Forty-three patients in Group F and 42 patients in Group S completed the study. No differences in maximum sensory block height (Group F = median T2, interquartile range [T2-T4], Group S = T3 [T2-T4], P = 0.077) or time to achieve block height (F = 9.3 ± 4.3 min, S = 9.7 ± 4.7, P = 0.64) were observed. The frequencies of hypotension (Group F = 35/43, Group S = 32/42, P = 0.56), ephedrine utilization (Group F = 32/43, Group S = 26/42, P = 0.21) and nausea (Group F = 15/43, Group S = 16/42, P = 0.76) were similar. Conclusion:Rapid intrathecal injection of hyperbaric bupivacaine does not affect spread of spinal anesthesia or the incidence of hypotension and nausea in parturients. (F = 9,3 ± 4,3 min, S = 9,7 ± 4,7, P = 0,64

The effect of injection speed on the spinal block characteristics of hyperbaric bupivacaine 0.5% in the elderly

“…Thus, our results cannot be directly compared with those of others. Speed of injection using hyperbaric solutions has not been found to be an important determinant in the spread of spinal anesthesia in young adults [8][9][10]. Neigh et al [8] found no difference in level of sensory anesthesia when a hyperbaric solution of tetracaine was injected at a rate of 1 or 0.2 ml/s.…”

“…However, data with regard to effect of injection speed using hyperbaric solutions for spinal block are limited [8][9][10][11]. Most studies using hyperbaric solutions of local anesthetics have not shown a difference in anesthetic profile [8][9][10], although a higher spread of sensory block with slow rate of injection has been reported [11].…”

Insidensi dan Faktor Risiko Hipotensi pada Pasien yang Menjalani Seksio Sesarea dengan Anestesi Spinal di Rumah Sakit Dr. Hasan Sadikin Bandung

“…Range (min-maks) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] 90 wanita hamil yang dilakukan anestesia spinal untuk tindakan seksio sesarea di RSHS. Pasien dengan status fisik ASA II dan III dengan usia termuda adalah 17 tahun dan tertua 46 tahun (Tabel 1).…”

Ausbreitung hyperbarer Lokalanästhetika im Spinalkanalmodell

“…Diese Injektionsgeschwindigkeit liegt bei Verwendung einer 27-G-Nadel im Rahmen durchschnittlicher klinischer Injektionsgeschwindigkeiten [16,28]. Unabhängig davon ist der Einfluss der Injektionsgeschwindigkeit auf die maximale Anästhesieausdehnung sowohl in der iso-als auch der hyperbaren Spinalanästhesie von untergeordneter Relevanz [10,25]. Der Vergleich beider Modellversuche ergab, dass die Ausbreitungshöhe nicht durch die mit der Steilheit der Lordose zunehmende Fließgeschwindigkeit bestimmt wird.…”