Dose Of Bupivacaine Research Articles

Spinal anesthesia with low dose bupivacaine and fentanyl for femur surgeries in elderly patients

Background and objectives: Decreasing the dose of intrathecal Bupivacaine may be useful to provide surgical anaesthesia with less hemodynamic disturbances especially in elderly patients but may be associated with inadequate anaesthesia for orthopaedic surgeries to perform. This can be overcome by adding Fentanyl to it. Materials and method: 60 elderly patients of American Society of Anaesthesiologists (ASA) grade II, scheduled for femur surgeries were randomly assigned to one of the two groups. Group B:(n=30) patients receiving Bupivacaine (0.5%) heavy 2.5ml (12.5mg) and Group BF:(n=30) patients receiving Bupivacaine (0.5%) heavy 1.5ml (7.5mg)+Fentanyl (25ug) 0.5ml+0.5 ml normal saline, total volume being 2.5ml. The characteristics of sensory and motor blockade, duration of effective analgesia, perioperative hemodynamics and complications were recorded. Results: The mean onset of sensory block and time to achieve peak sensory level was early, time to achieve regression to L1 level and duration of effective analgesia was longer in group BF ad the difference was highly significant (p<0.001). There was no significant difference in motor blockade characteristics between two groups. Incidences of hypotension were more in group B compared to group BF. Conclusion: Low dose intrathecal bupivacaine (7.5 mg) with fentanyl (25mcg) can provide adequate surgical anaesthesia and better hemodynamics and can be used in elderly patients for femur surgeries.

Comparison of quadratus lumborum versus continuous epidural block for laparoscopic donor nephrectomy: analysis of postoperative analgesia and motoric ability

Pain management in post transperitoneal laparoscopic nephrectomy is a key to early recovery. Different types of regional anesthesia techniques have been applied for managing post-operative pain. However, the results are still not satisfactory. This study aims to compare effectiveness of ultrasound-guided bilateral Quadratus Lumborum (QL) block with continuous epidural analgesia in improving post transperitoneal laparoscopic nephrectomy analgesia and motoric mobility. This is a randomized controlled trial that included 26 healthy living kidney donor patients. All subjects were randomized to receive preoperatively bilateral QL block (n=13) or continuous epidural analgesia (n=13). Subjects in QL group received 20 mL of bupivacaine 0.25% bilaterally and subjects in epidural group received continuous bupivacaine 0.125% infusion 6 mL/hour. Numerical rating scale (NRS), Bromage score, and duration of urinary catheterization were recorded. The results presented no significant differences in NRS scores at rest and movement, and Bromage score between QL block group and epidural block group in at 2,6,12,24 hours after surgery. The QL block group received significantly lower total dose of bupivacaine (p<0.001) and duration of urinary catheterization was significantly shorter (p=0.001) compared to epidural group. This study found that QL block produced similar postoperative NRS and Bromage score with fewer dose of bupivacaine and shorter duration of urinary catheterization compared with continuous epidural analgesia within 24 hours.

The block of the crural nerve as a technique of analgesia postoperative knee surgery

Ten ASA patients 1 and 2 are being studied, aged 18 to 54 years (mean ± SD: 37 ± 17 years) and undergoing knee surgery. At the end of the surgical procedure under general anesthesia, an epidural catheter is placed in the colorectal cavity. After radiological monitoring, a large dose of bupivacaine 0.5% epinephrine 2.5 mg • kg-1 was injected. A 0.125% non-adrenaline bupivacaine was maintained for 48 hours at a dose of 0.25 mg • kg-1 • h-1. The pain score measured using a visual analog scale before occlusion was 5.0 ± 1.9. From the 6th hour to the 48th hour, it decreased significantly. The plasma concentrations of bupivacaine obtained at 24, 36, and 48 hours were significantly higher than those at 30 minutes, and 1, 6, and 12 hours. The steady-state concentration of bupivacaine was 1.78 ± 0.59 μg • ml-1. The clearance rate of bupivacaine was 2.59 ± 0.91 ml • min-1 • kg-1. No neurological complications were observed.

Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section.&#x0D; Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine.&#x0D; Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p&lt;0.05) and Nausea and vomiting (16.20% vs. 27%, p&lt;0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group.&#x0D; Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

Comparative Evaluation of Different Dose of Bupivacaine for Pain Control in Cesarean Section

Comparative Evaluation of Different Dose of Bupivacaine for Pain Control in Cesarean Section

Height-based dosing algorithm of bupivacaine in spinal anaesthesia for decreasing maternal hypotension in caesarean section without prophylactic fluid preloading and vasopressors: study protocol for a randomised controlled non-inferiority trial

IntroductionEffectively preventing or treating spinal-induced maternal hypotension is considered to be the Holy Grail of obstetric anaesthesia. Prophylactic fluid preloading and vasopressors decrease hypotension but may aggravate heart load, induce...

(143) Long Term Use of Intrathecal Bupivacaine for Treatment of “Failure to Thrive” in a Child

This 6-year-old female was diagnosed with failure to thrive at 4 months of age. She had multiple gastrointestinal interventions and tried multiple medications, including neuropathic medications. They made no significant difference in her feeding or pain status. By 18 months of age she was on total parenteral nutrition (TPN) and had had two infections. Due to her limited life expectancy, she was referred to the pediatric chronic pain clinic for any possible interventions. A celiac plexus block was performed on using 0.25% bupivaciane which resulted in 3 weeks of feeding through her GJ tube without significant pain when she was two years of age. After it wore off, a second block was performed with similar results the next month. An epidural trial of bupivicaine was successful for GJ feeding, so an intrathecal pump was implanted. Her oral baclofen dose and bupivacaine were infused through the pump. She has continued with intrathecal pumps over the last four years. Her growth went from 2% to 60% and her length increased in a similar fashion. Her bupivacaine dose has not changed. She had a small amount of morphine added after the first year of the pump, which has remained stable. She was able to decrease a number of oral medications, such as amitriptyline and lyrica. No increase in bupivacaine has been needed. No signs of tachyphylaxis has been seen. No neurologic issues other than with her GI tract, which has continue to have issues with functioning correctly, have been noted. Long term use of bupivacaine has not been previously reported. This pump is still working and she is still doing well.

Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients.

BackgroundHypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in elderly patients by studying the effect of two different dosages of intrathecal bupivacaine.MethodsThis prospective cohort study included 64 patients aged >65 years scheduled for procedures under SA; the patients received either 15 mg bupivacaine (the medium dose [MD] group) or 10 mg bupivacaine and 5 μg sufentanil (the low dose [LD] group). Blood pressure and CO were monitored throughout the procedure using Nexfin™, a noninvasive continuous monitoring device using a finger cuff.ResultsThirty-three patients received MD and 31 received LD and there was no mean difference in baseline hemodynamics between the groups. On an average, the CO decreased 11.6% in the MD group and 10.0 % in the LD group. There was no significant change in SVR. Incidence of a clinically relevant decrease in stroke volume (SV) (>15% from baseline) was 67% in the MD and 45% in the LD groups (P<0.05).ConclusionCO and blood pressure decreased significantly after the onset of SA in elderly patients. This is mainly caused by a decrease in SV and not by a decrease in SVR. There was no difference in CO and blood pressure change between dosages of 10 or 15 mg bupivacaine.

The Effect of Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies

Background: lumbar subarachnoid block is a technique which requires a small dose of heavy bupivacaine to provide rapid and reliable surgical anaesthesia. Duration of spinal anaesthesia may be prolonged by addition of opioids, clonidine, neostigmine, or vasoconstrictor agents to the local anesthetic drug for better post-op pain relief. This study is designed to investigate the effects of intravenous dexmedetomidine on the duration of sensory and motor blockade induced by intrathecal administration of bupivacaine, and its associated adverse events. Aims and Objectives: To assess the effect of Dexmedetomidine infusion on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess the incidence of intra operative side effects, if any. Subjects and Methods: This study was done under the department of Anaesthesiology, Govt. T. D. Medical College Hospital, Alappuzha, Kerala for a period of 8 months. A double blind prospective randomized control study was done.50 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named A and B using computer generated randomization. Results: The duration of analgesia compared and Post-operative pain was evaluated by Visual Analogue Scale. Duration of analgesia is the time taken from the administration of the drug to the time when the patient complains of pain of &gt; 50 in Visual Analogue Scale. The duration of analgesia was longest in patients received intravenous dexmedetomidine along with spinal bupivacaine. Side effect like respiratory depression not observed in either group. Conclusion: In conclusion, intravenous infusion of dexmedetomidine added to subarachnoid block with bupivacaine offered prolonged analgesia in adult patients undergoing herniorrhaphies, without increasing the incidence of adverse effects.

Minimal Local Analgesic Dose of Intrathecal Bupivacaine and Ropivacaine in Patients Undergoing Cesarean Section: A Comparative Study

Introduction: Spinal anesthesia is a reasonable option for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opiods. Ropivacaine is considered a valid and safe alternative to bupivacaine for intrathecal anesthesia. This study aims to determine the median effective dose (ED50) of intrathecal bupivacaine and ropivacaine for cesarean section and defines this as the minimum local anesthetic dose (MLAD). Methods: Forty pregnant women undergoing elective cesarean section were allocated and randomized into two groups. The initial dose was 13mg for both ropivacaine and bupivacaine groups and was increased or decreased of 0.3mg, using the up-down sequential allocation technique. Efficacy was accepted if adequate sensory dermatomal anesthesia to pinprick to T6 was attained within 20 minutes after intrathecal injection and required no supplemental epidural injection for procedure until at least 50 minutes after the intrathecal injection of test drugs. The MLAD for both bupivacaine and ropivacaine was calculated with 95% confidence interval using the formula of Dixon and Massey. Comparison of different variables between the groups was done using t-test with significant p value at &lt; 0.05. Results: The two groups were comparable in terms of demographic profile and clinical characteristics. The MLAD of ropivacaine and bupivacaine were 11.63 mg (95% CI, 11.5-12.92) and 10.459 mg (95% CI, 10.12-10.87) respectively. The potency ratio between spinal ropivacaine and bupivacaine was 0.89. Conclusion: Ropivacaine provided clinically surgical anaesthesia of shorter duration without compromising neonatal outcome and can be used as a safe alternative to bupivacaine.

Lumbar Spine Surgeries Under Spinal Anesthesia in High-Risk Patients: A Retrospective Analysis

To determine outcomes of spinal anesthesia (SA) in high-risk patients undergoing lumbar spine surgery in whom general anesthesia (GA) was contraindicated. A retrospective study was conducted in Bansal Hospital, Bhopal, India. SA was achieved with a heavy spinal dose of bupivacaine administered in the sitting position. After assessing sensory level, patients were placed into prone position. Throughout surgery, hemodynamic parameters were monitored. At the end of surgery, patients were placed into supine position and taken out of the operating room for monitoring in the recovery room. Postoperatively, time spent in the postanesthesia care unit, hemodynamic changes, incidence of nausea and vomiting, urinary retention, spinal headache, analgesic use, regression of sensory block, and length of hospital stay were documented. Patient and surgeon satisfaction was also assessed. The study included 18 high-risk patients with lumbar spine disease. Twelve patients were classified as American Society of Anesthesiologists IV, and 6 were classified as American Society of Anesthesiologists III. Ten patients underwent microdiscectomy, and 8 patients underwent canal and lateral recess decompression. None of the patients had anesthetic or surgical complications. Postoperative pain relief was excellent. There were no incidences of postoperative vomiting or urinary retention. Only 2 patients (11.11%) developed nausea. Both surgeons and patients reported a high level of satisfaction. SA was 12% cheaper than general anesthesia. SA is a safe, reliable, and satisfactory alternative to general anesthesia in high-risk lumbar spine surgeries. Postoperative morbidity and mortality can be reduced by SA and spinal analgesia techniques. SA allows good perioperative hemodynamic stability. It is also more cost-effective.

Effect of Artemisia Aucheri.L and Bupivacaine Encapsulated Nanoparticles on Nociceptive Pain.

The purpose of this study was to evaluate the antinociceptive interaction between bupivacaine and Artemisia aucheri. L encapsulated nanoparticles. The effect of bupivacaine and Artemisia aucheri.L alone, and their encapsulated co-administration was assessed using the 3% formalin test in rat. Increasing doses of bupivacaine (31.6, 100, 178, and 316 mg/kg) or Artemisia aucheri.L (5.6, 10, 17.8, and 31.6 mg/kg) were given i.p. 10 min before 3% formalin administration. The possible mechanism(s) of action were analyzed for the encapsulated co-administration, naloxone (1 mg/kg) and N (G)-nitro-L-arginine methyl ester (L-NAME) (3 mg/kg) were used. Interaction index and isobolographic analysis and the demonstrated a synergistic effect. The experimental ED30 was lower as compared with theoretical ED30. Naloxone was shown to reduce the antinociceptive effect of the encapsulated co-administration. These data suggest that the bupivacaine and Artemisia aucheri.L encapsulated nanoparticles gave a synergistic effect.

Bupivacaine injection combined with recession of antagonist rectus muscle to treat sensory strabismus

ABSTRACTPurpose: This study aims to evaluate the effect of bupivacaine injection at 1.5% combined with recession of the antagonist rectus muscle to treat sensory strabismus in adult patients.Methods: Nine patients with a horizontal deviation, visual acuity of <20/60 in the worst-seeing eye, and no previous strabismus surgery were selected. Patients with vertical strabismus were excluded. Lateral rectus (LR) recession was performed in patients with exotropia and medial rectus (MR) recession in patients with esotropia according to Park’s Table, as modified by Wright. Bupivacaine 1.5 mL at 1.5% was injected in the antagonist of the recessed muscle. The patients were evaluated after 1, 7, 30, 60, 90, and 180 days of the procedure. Successful motor alignment was defined as within 10 prism diopters (PD) of orthophoria. Dose-response was considered as the total amount of correction, divided by recession performed in millimeters, associated with bupivacaine injection in the antagonist muscle.Results: Of the patients, 44% (4/9) had a successful motor alignment. The mean correction for exotropia (n = 5) with a preoperative horizontal deviation of 50 ± 6.12 PD was 23 ± 14.4 PD with a dose-response of 2.6 PD/mm. For esotropia (n = 4), the mean correction of 21.25 ± 4.8 PD was achieved with a preoperative deviation of 28.7 ± 14.9 PD with a final dose-response of 5 PD/mm. All unsuccessful patients had a preoperative deviation of ≥45 PD.Conclusion: Bupivacaine injection in the antagonist of a recessed extraocular muscle (EOM) appears to add an effect to the standard dose-response of a muscle recession. For patients with esotropia (<25 PD), a single MR recession combined with bupivacaine in the LR can produce a successful motor alignment. For patients with large horizontal strabismus (>45 PD), larger bupivacaine doses (volume and concentration) combined to larger recessions may be needed.

Intraoperative and postoperative effects of different doses of bupivacaine: a comparative and prospective study for lower limbs surgeries

Background Central neuraxial block is the gold standard for surgeries below the level of the umbilicus, especially for lower limb operations. Bupivacaine of different concentrations are used for regional blocks and the side effects are attributed to the concentration of the local anaesthetics used. Objective The aim of this study was to prospectively investigate the intraoperative and postoperative effects of different doses of bupivacaine in lower limb surgeries. Methodology A double-blind randomized controlled study was conducted on 120 patients scheduled for emergency lower limb surgeries at Ahmadu Bello University Teaching Hospital from January to December 2017. The patients were randomly grouped into two groups: 1 and 2. The patients in group 1 received 10 mg of 0.5% bupivacaine and 10 μg of fentanyl, whereas those in group 2 received 7.5 mg of 0.5% bupivacaine and 10 μg of fentanyl. Parameters considered included the hemodynamic indices, quality of intraoperative analgesia, onset time of sensory and motor blockade, level of sensory and motor blockade, and duration of the sensory and motor blockade. A P value less than 0.05 was considered statistically significant. Results There was no statistically significant difference (P Conclusion This study has established that 7.5 mg of 0.5% bupivacaine with 10 μg fentanyl has operative analgesia of equal efficacy as 10 mg of 0.5% bupivacaine.

Efficacy of low dose bupivacaine with intrathecal fentanyl for cesarean section on maternal hemodynamic: Systemic review and meta-analysis.

Hypotension during spinal Anesthesia is the most common complication with maternal and neonatal morbidity and mortality. Low dose bupivacaine with intrathecal fentanyl is recommended as strategy to prevent spinal Anesthesia induced hypotension and related complications. The aim of this systemic review is to evaluate the efficacy of low dose bupivacaine with Intrathecal fentanyl on the improvement of maternal and neonatal outcomes compared to conventional dose bupivacaine among mothers who undergone cesarean section. We conducted a systemic search of the electronic databases of Pubmed, Medline, LILACS and others with PICO strategy for randomized controlled clinical trials comparing low dose bupivacaine with fentanyl and conventional dose bupivacaine for cesarean section. Joanna Briggs Institute (JBI) standardized data extraction form was used for data extraction and finally entered into Review Manager for data synthesis. Ten Randomized trials (552) were included in this review. Incidence of hypotension was less likely in mothers who received low dose bupivacaine with Fentanyl as compared to those with conventional dose of bupivacaine alone (RR = 0.43, 95% confidence interval (CI) 0.12-0.47, ten trials, 552 participants). The review revealed that Low dose bupivacaine combined with intrathecal Fentanyl decrease incidence of hypotension.

Large Dose Bupivacaine 0.5% versus Small Dose in Elective Cesarean Section.

Background and Aim:The spinal anesthesia in a cesarean section is still presenting a challenge to the anesthetist in the form of either severe hypotension from large bupivacaine dose or insufficient satisfactory anesthesia level conditions as a result of small bupivacaine dose. In this study, we tried to solve this challenge by increasing the dose of bupivacaine to achieve a proper spinal level accompanied by prolonged sitting up to avoid hypotension.Patients and Methods:We included 53 patients in this study whom were randomly divided into two groups, namely Group B and Group C. In Group B (25 patients), each patient received 3 mL of bupivacaine and left 5 min sitting up, whereas in Group C (28 patients), each patient received 2.5 mL of bupivacaine and was asked to lie supine immediately. Both groups were tested for hypotension, ephedrine dose, and sensory block level.Results:The present study showed a statistically significant lower dose of ephedrine which was given in Group B (7.2 ± 15.684 mg in Group B versus 27.86 ± 12.04 mg in Group C with P < 0.05). The proper anesthesia level was achieved equally in both groups.Conclusions:Large dose 15 mg of bupivacaine with the prolonged sitting position will lead to fewer incidences of hypotension and proper anesthesia block.

A comparative study between the effect of intrathecal hyperbaric bupivacaine with fentanyl and hyperbaric levobupivacaine with fentanyl for knee arthroscopy

Background The use of levobupivacaine as a pure S (−) enantiomer of bupivacaine was progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration. The aim of this work was to compare the effectiveness of lower-dose local anesthetics’ use together with higher opioid dose to decrease the side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in knee arthroscopy. Patients and methods After hospital ethics committee approval and getting written informed consent from patients, 100 patients with American Society of Anesthesiologists grade I–II, aged 18–40 years were included in the study. They were randomized to either group A receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine with 25 μg (0.5 ml) fentanyl, or group B receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine with 25 μg (0.5 ml) fentanyl. Results Hemodynamic parameters such as the 45th minute mean arterial pressure of group B was found to be lower (P&lt;0.05). In group A, maximum sensorial block level and postoperative visual analog scale scores were higher (P&lt;0.05). Onset of motor block time, time to maximum motor block, time to sensorial block, reversal of two dermatome and first analgesic need were similar in both groups. Conclusion Intrathecal hyperbaric levobupivacaine–fentanyl combination is a better and good alternative to bupivacaine–fentanyl combination in knee arthroscopy, as it maintains hemodynamic stability.

Intrathecal nalbuphine versus fentanyl as an adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized double-blind study

Background Opioids have been used as an adjunct to bupivacaine in spinal blockade to enhance the onset of action, to improve the quality of intraoperative and postoperative analgesia, and to increase the duration of block. Fentanyl is a synthetic opioid agonist and nalbuphine is a synthetic opioid agonist-antagonist. The present study aimed to compare the effects of adding nalbuphine or fentanyl as an adjunct to bupivacaine on the characteristics of spinal blockade, quality of postoperative analgesia, and on fetomaternal outcome after elective cesarean section. Participants and methods A total of 80 full-term parturients scheduled for elective cesarean section were randomly allocated into two groups. Nalbuphine group (BN group) included parturients who received 12.5 mg of 0.5% hyperbaric bupivacaine with 800 μg nalbuphine intrathecally. Fentanyl group (BF group) included parturients who received the same dose of hyperbaric bupivacaine with 25 μg fentanyl intrathecally. Subarachnoid blockade characteristics, duration of postoperative analgesia, the amount of postoperative analgesic requirements, maternal adverse effects, and neonatal outcome were compared. Results Onset of sensory and complete motor block, maximum height of sensory block, and time to two-segment sensory regression were significantly faster in BF group than in BN group. Maximum dermatomal block level was significantly higher in BF group than in BN group. The duration of motor block and the quality of anesthesia of both groups were comparable. Durations of postoperative complete and effective analgesia were highly significantly longer in BN group than the corresponding durations in BF group (P Conclusion As an adjunct to hyperbaric bupivacaine in spinal block, fentanyl was superior to nalbuphine in enhancing the onset of both sensory and motor block. Nalbuphine is superior to fentanyl in increasing the duration of postoperative complete and effective analgesia and in decreasing incidences of pruritus and shivering, and both drugs have similar effects on neonatal APGAR score and neurologic and adaptive capacity score.

Comparison between position change after low-dose spinal anesthesia and higher dose with sitting position in elderly patients: Block characteristics, hemodynamic changes, and complications

Background:Large numbers of patients are presenting for surgeries with aging-related pre-existing conditions that make them at higher risks of adverse outcomes. Hemodynamic instability due to high sympathetic nerve block largely limits the use of conventional dose spinal anesthesia in high risk elderly patients.Aims and Objectives:We aimed to compare the hemodynamic stability and the block characteristics in low dose spinal anesthesia (5 mg) with immediate position change into supine position versus higher dose of spinal anesthesia (10 mg) with maintaining patient position in sitting position for 3 minutes after the block in elderly high risk population.Settings and Design:This study was a prospective randomized controlled double-blinded clinical study.Materials and Methods:This study was carried on 70 patients of American Society of Anesthesiologists physical status classes I, II, and III aged 50 years old and above, who were scheduled for elective knee and below knee orthopedic surgeries expected to last for 40-60 minutes under spinal anesthesia. Patients were randomly allocated into two groups: group (A) Sitting group n= 35 patients that received 10 mg hyperbaric bupivacaine 0.5% in 2 mL volume intrathecal at level lumbar (L4-5) in sitting position and remained in this position for 3 minutes before turning supine. And, group (B) Supine group n = 35 patients received 5 mg (low dose) intrathecal hyperbaric bupivacaine in 2 mL volume (1 mL hyperbaric bupivacaine 0.5% diluted with 1 ml sterile distilled water) at L4-5 in sitting position then turned supine immediately. The injection will be in the midline over 30 seconds by 25 gauge(G) Quincke needle. We measured the changes of mean arterial blood pressure, heart rate, O2 saturation and the incidence of hypotension and bradycardia intraoperatively as a primary outcome. Also, we measured the characteristics and the duration of the sensory and motor blocks, the duration required till return of bladder function and the satisfaction levels of both the patients and the surgeons as secondary outcomes.Statistical Analysis Used:Student's t-test and Chi-square test were used for analysis.Results:As regards hemodynamics, mean arterial blood pressure and heart rate were significantly lower in group A compared to group B; P-value <0.05, during the intraoperative period, while MABP and HR were significantly decreasing in group A during the initial intraoperative period at 5 min, 10 min, 15 min, 20 min, 25 min, 30 min and 35 min, but in group B these parameters were statistically insignificant throughout the whole procedure P-value >0.05. As regards oxygen saturation, there were no significant differences between both groups or within the same group during the whole intraoperative period. Comparing sensory and motor blocks, sensory block was significantly higher and motor block was significantly dense in group A compared to group B during the first intraoperative period at 5 min, 10 min, 15 min, 20 min and 25 minutes. The recovery times from sensory and motor blocks were significantly longer in group A compared to group B (P-value <0.001). Also, the void recovery time was significantly longer in group A (129.29 ± 5.87 min) compared to group B (114.77 ± 8.24 min). In group B, patient satisfaction was significantly better (25 excellent/ 10 good) compared to group A (10 excellent/25 good). Also, surgeon satisfaction was statistically significantly better in group B (23 excellent/12 good) compared to group A (14 excellent/21 good). As regards side effects, in group A, 3 patients had to receive ephedrine due to significant reduction in MABP while no patients in group B had significant hypotension or bradycardia throughout the intra operative period.Conclusion:We concluded that the use of small dose of heavy bupivacaine 0.5% (5 mg) with immediate patient position changing to supine position provided good spinal block characteristics in elderly population without any hemodynamic side effects, also with better patient and surgeon satisfaction levels compared to higher doses of heavy bupivacaine (10 mg) even if we maintained patient position in the sitting position for 3 min after the block.

Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries

Background Continuous spinal anesthesia (CSA) is a reliable method for providing effective anesthesia and offers considerable advantages over ‘single-shot’ spinal or epidural anesthesia, as it provides the performance of well-controlled anesthesia using small doses of local anesthetics and a definite end point with less failure rate. Materials and methods A total of 100 patients of American Society of Anesthesiology grades III–IV were scheduled for elective major orthopedic lower limb surgeries. They were divided into two groups: one received CSA using spinocath set, and the other group received continuous epidural anesthesia (CEA). The doses of local anesthetic used, hemodynamic variables, a degree of technical difficulties, and the incidence of complications were recorded. Results The performance time was significantly shorter in the CEA group. The total dose of bupivacaine and number of top-up doses were significantly smaller in the CSA group than in the CEA group. The onset of sensory blockade level and motor blockade was significantly longer with CEA. Regarding the mean arterial pressure, there was a statistically significant difference between the two groups. The number of patients treated for hypotension and total dose of ephedrine was more in CEA group, but there was no statistical difference between the two groups. No major complications were observed in any patient in both groups. Conclusion We conclude that CSA is an effective and safe choice with hemodynamic stability and negligible failure rate, for prolonged procedures in elderly high-risk patients and in those with possible difficulties in administration of general anesthesia.