Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

Abstract

We hypothesized that cooling hyperbaric bupivacaine from 23 to 5°C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8ml of 0.5% hyperbaric bupivacaine intrathecally at either 5°C (group I, n=50) or at 23°C (group II, n=50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. The rate of unilateral spinal anesthesia at 15 and 30min was significantly higher in group I (p=0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p=0.014 and 0.037, respectively). The density and viscosity of the solution at 5°C was significantly higher than at 23°C (p<0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3min) and motor block recovery was shorter (157.6 vs 193.4min) (p<0.0001). Cooling of hyperbaric bupivacaine to 5°C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.