Spinal Analgesia with Glucose‐Free Bupivacaine ‐ Effects of Volume and Concentration

Bengtsson, Mats; Malmqvist, Lars-Åke; Edström, H. H.

doi:10.1111/j.1399-6576.1984.tb02124.x

Cited by 38 publications

(18 citation statements)

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“…Spinal anaesthesia with plain bupivacaine is characterized by a great individual variation in the cephalad spread of the block (6,12,19,(29)(30)(31)(32). The interaction between the position of the patient during injection and the density of the local anaesthetic solution is minimal.…”

Section: Plain Bupivacainementioning

confidence: 99%

Bupivacaine spinal anaesthesia

Tuominen

1991

Acta Anaesthesiol Scand

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Section: Plain Bupivacainementioning

confidence: 99%

Bupivacaine spinal anaesthesia

Tuominen

1991

Acta Anaesthesiol Scand

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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.…”

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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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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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“…9 In order to elucidate these findings Lui et al , 7 compared HB with IB lidocaine in a glass spine model placed in the vertical position. With this model the HB solution was more concentrated at the lower end of the column, whereas the IB formulation tended to concentrate around the site of injection.…”

Section: Discussionmentioning

confidence: 99%

“…Study of the cutaneous resistance with galvanometry (Grass Model 7E Polygram). An electrode for painful stimuli was placed in the left supra-clavicu -lar region, while the other electrodes were located in the mid clavicular zone at the level of T 5 , T 9 and on the iliac crest on the same side (right).…”

Section: Methodsmentioning

confidence: 99%

Comparison of differential blockade during spinal anesthesia using isobaricvs hyperbaric lidocaine 2%

Jankowska¹,

Veillette

2000

Can J Anesth/J Can Anesth

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Purpose: To compare the extent of the sensory, motor and sympathetic block produced by a single dose of 60 mg lidocaine at the same concentration (2%) and volume but at different baricity injected intraspinally.Method: In a randomised double blind study, 40 ASA I -II patients were scheduled for elective surgery (orthopedic, urologic, peripheral vascular and lower digestive procedure). They were divided in two groups. Twenty patients received 60 mg lidocaine 2% in a hyperbaric solution and 20 received 60 mg lidocaine 2% in a isobaric solution. The levels of sensory (pinprick, ice) motor (Bromage scale) and sympathetic blockade (galvanometry, cutaneous blood flow, temperature) were measured at 0, 5, 10, 15, 20 and 30 min.Results: There were no differences between the groups with regard to maximal height of sympathetic block, sensory level to pinprick: T 5 ± 2.4 for isobaric group, T 6 ± 3.6 for hyperbaric group or to cold: T 3 ± 2.3 for isobaric group, T 4 ± 2.7 for hyperbaric group. Hyperbaric lidocaine 2% produced a more pronounced sensory (pinprick, ice) and motor block on the dependant than on the non-dependant side. Conclusion:The baricity of 60 mg lidocaine injected intraspinally in the lateral decubitus position did not influence the cephalad spread of sensory or sympathethic blockade. In the hyperbaric group, the dependent side showed a more pronounced sensory (pinprick, ice), and motor block.Objectif : Comparer l'étendue du bloc sensitif, moteur et sympathique d'une dose de 60 mg de lidocaïne 2 % à baricité différente, administrée en injection intrarachidienne, en décubitus latéral.Méthode : Quarante patients ASA I-II, dont l'opération était prévue, ont participé à une étude randomisée à double insu. Ils ont été répartis aléatoirement en deux groupes. Vingt patients ont reçu une anesthésie rachidienne avec 60 mg de lidocaïne isobare à 2 %, et 20 patients avec 60 mg de lidocaïne hyperbare à 2 %. Ont été mesurés sur une période de 30 min (0, 5, 10, 20, 30 min): l'expansion du bloc sympathique (galvanométrie, étude du flot vasculaire -Doppler -et prise de température aux extrémités), du bloc sensitif (aiguille et glace, côtés gauche et droit) ainsi que l'intensité du bloc moteur (gauche et droit). Une différence statistique de P < 0,05 était considérée significative.Résultats : Nous n'avons trouvé aucune différence significative intergroupe de diffusion céphalique de la sensibilité au froid et à l'aiguille. Les variations de température, de flot vasculaire, et de résistance cutanée étaient également comparables. Le bloc moteur était complet en 15 min chez tous les patients du groupe isobare, tandis que quelques patients n'avaient qu'un bloc partiel à droite (côté non dépendant) dans le groupe hyperbare, et ce, après 30 min.Conclusion : La baricité d'une solution de 60 mg de lidocaïne 2 % intrarachidienne n'influence pas le niveau céphalique sympathique, sensitif ou moteur en décubitus latéral. Cependant, un effet moteur plus marqué du côté déclive se dégage dans le groupe hyperbare.

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Spinal Analgesia with Glucose‐Free Bupivacaine ‐ Effects of Volume and Concentration

Cited by 38 publications

References 4 publications

Bupivacaine spinal anaesthesia

Bupivacaine spinal anaesthesia

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

Comparison of differential blockade during spinal anesthesia using isobaricvs hyperbaric lidocaine 2%

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