Dose Of Hyperbaric Bupivacaine Research Articles

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

ADVANTAGES OF LATERAL INJECTION OF HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR ORTHOPEDIC SURGERY

Abstract. The use of spinal anesthesia is the most frequent method of analgesia, therefore prolonging the duration of anesthesia and increasing its safety is a priority during operations on the lower extremities.
 The aim of the study: to extend the duration of the sensory block during spinal anesthesia, ensuring its safety for the patient.
 Materials and methods. To conduct the study, we analyzed the use of spinal anesthesia during surgical interventions in traumatology and orthopedics in 50 patients, divided into two study groups. The 1st research group (control) included 25 patients (18 men, 7 women) who underwent spinal anesthesia with the recommended graded dose of local anesthetic according to the patient's height, followed by supine position for up to 20 minutes. The II study group included 25 patients (17 men, 8 women) who underwent spinal anesthesia with a dose of local anesthetic determined by the height of the patient, followed by lateral position for up to 20 minutes.
 The results. The duration of the sensory block in patients of the I group was 252.2±74.32 min., and in the II – 299.2±62.44 min. respectively (р = 0.0193). During the assessment of SBP and heart rate in both study groups, a decrease in mean arterial pressure and heart rate after spinal anesthesia was determined, which was more pronounced during spinal anesthesia with subsequent application to the back. The volume of crystalloid infusion therapy during surgery was compared in both study groups. In patients of the I group, it was 2042±663.9 ml, and in the II group – 2028±600.36 ml. (p=0.938, the comparison was made according to the Student's test). The frequency of use of phenylephrine (for correction of hypotension with SBP < 65 mmHg) in the I group was 0.092±0.016 ml, in the II group – 0.004±0.002 ml. (p – 0.018, the comparison was carried out according to the Mann-Whitney test). Atropine sulfate was used to correct bradycardia (heart rate <50 beats/min), in group I – 0.16±0.031 ml, in group II – 0.14±0.034 ml. (p – 0.587, the comparison was carried out according to the MannWhitney test).
 Conclusions. 1. Selection of the dose of hyperbaric bupivacaine depending on the height of the patient ensures the necessary effectiveness of spinal anesthesia. 2. The duration of motor and sensory blockade is significantly higher by 16 % in the group with the lateral position of the patient. 3. When using a hyperbaric local anesthetic for spinal anesthesia in the lateral position, the frequency of cardiovascular complications decreases compared to the control group

Prolonged duration of spinal anesthesia with normal dose of hyperbaric bupivacaine: case report

Background: Spinal anesthesia has been used for over 120 years as a relatively safe and effective method technique. A well-known anesthetic, bupivacaine is the most widely used local anesthetic in the subarachnoid space. We report a case of prolonged sensory and motor blockade in a patient undergoing spinal anesthesia with 15 mg of 0.5% hyperbaric bupivacaine without any adjuvant, which lasted 32 hours to regress. Case Report: The patient was a 36‑year‑old female, obese, with no known comorbidities, who was undergoing surgical treatment of varicose veins of the lower limbs. Normal pre-operative exams. After sedation with midazolam 2.5 mg, the patient was in a sitting position and 3 attempts at subarachnoid puncture with a 27G cutting needle were unsuccessful. Another attempt with a 25G cutting tip needle was successful and injected 15 mg of 0.5% hyperbaric bupivacaine without adjuvants. The surgical procedure lasted 3 hours without cardio circulatory changes, and the patient was referred to PACU. Ten hours after the persistence of sensory and motor blocks. MRI of the thoracolumbar spine was performed without evidence of alteration. After 17 hours, both sensory and motor blocks remained, requiring bladder catheterization. After 23 hours, the neurological examination was normal, showing the permanence of both blocks. The complete return of sensory and motor blocks occurred after 32 hours, with hospital discharge in 4 hours, after complete regression of the subarachnoid block. Conclusions: In conclusion, an unexpectedly prolonged spinal block can be seen with regular doses of 0.5% hyperbaric bupivacaine. We cannot determine the exact etiology in our present case, with a normal MRI thoracolumbar.

Scope of spinal anaesthesia extends beyond the administration of dose of hyperbaric bupivacaine

Scope of spinal anaesthesia extends beyond the administration of dose of hyperbaric bupivacaine

Fractionated dose of hyperbaric bupivacaine for hemodynamic stability and prolonged duration of anaesthesia in high-risk geriatric patients undergoing unilateral hip surgeries under subarachnoid block- A case series

Poor cardiopulmonary reserve, multiple comorbidities and polypharmacy in geriatric patients result in significant hemodynamic changes after the subarachnoid block (SAB) which are often unpredictable and requires administration of fluids, vasopressors, invasive monitoring and ICU admission leading to poor post operative outcome especially in patients belonging to American Society of Anaesthesiologists Physical Status (ASA PS) 3 & 4. Fractionated dose of hyperbaric bupivacaine for preferential unilateral lower limb blockade is found to have excellent hemodynamic stability and more duration of action making it a better alternative to the bolus dose in unilateral hip surgeries in high-risk geriatric patients. Here is a case series of 20 high risk geriatric patients who successfully underwent unilateral hip surgeries under fractionated dose of spinal anaesthesia with a stable perioperative hemodynamics.

Graded dosage of local anesthetic for spinal anesthesia during orthopedic and trauma surgeries on the lower extremities

Background. The development of a clear algorithm of a local anesthetic dosage for spinal anesthesia during surgeries on the lower extremities is an urgent issue, even after a century of using this method of analgesia. The aim of our study is to improve the efficiency and safety of spinal anesthesia during lower extremity surgery in orthopedic and trauma patients by developing a local anesthetic dosage algorithm. Materials and methods. The conducted study is based on the analysis of the bilateral spinal anesthesia methods in 75 patients with degree I–II ASA operational risk during orthopedic and trauma surgeries on the lower extremities who were divided into 3 study groups. Spinal anesthesia was performed using 0.5% bupivacaine, with the anesthetic dosage algorithm developed according to the patients’ height (group III) and the standard recommended dosage (group I, patients of short height, and group II, patients’ height > 180 cm). Results. When studying the hemodynamic indicators, the heart rate before surgery was as follows: in the first group, 73 ± 8 bpm, in the second group, 78 ± 6 bpm, in the third group, 79.32 ± 14.47 bpm. Thirty minutes after the injection of the anesthetic, the heart rate in the group 1 was 68 ± 5 bpm, and three hours after, it was 71 ± 9 bpm. In the group 2, the heart rate of patients 30 minutes after the injection of the anesthetic was 79 ± 7 bpm, three hours after, it was 84 ± 9 bpm. In the group 3, the heart rate of patients 30 minutes after the administration of the anesthetic was 71.56 ± 14.14 bpm, three hours after the injection, it was 71.280 ± 9.002 bpm. Data on systolic blood pressure before surgery was started were as follows: in the first group, 139.6 ± 12.3 mmHg, in the second group, 136.0 ± 9.6 mmHg, in the third group, 138.40 ± 16.18 mmHg. During the surgical intervention, blood pressure indicators in the group 1 were: 30 minutes after the introduction of the anesthetic — 113.0 ± 7.1 mmHg, 3 hours after — 122 ± 14 mmHg; in the second group: 30 minutes after the injection of the anesthetic — 138.0 ± 10.2 mmHg, 3 hours after — 141.0 ± 12.5 mmHg; in the third group: 30 minutes after the administration of the anesthetic — 102.48 ± 13.47 mmHg, 3 hours after the introduction — 118.2 ± 10.0 mmHg. The average duration of the sensory block in the group 1 was 182.5 ± 17.2 min, of the motor block — 130.0 ± 24.8 min; in patients of the group 2, the sensory block lasted 70.6 ± 13.1 min, and the motor block 23.3 ± 6.7 min; in the group 3, the duration of sensory block was 252.20 ± 74.32 min and of the motor block — 198.2 ± 59.0 min. Conclusions. 1. The use of small doses of hyperbaric bupivacaine does not affect hemodynamic parameters but reduces the quality and duration of anesthesia in tall patients. 2. The frequency of complications during spinal anesthesia does not increase with an increase in the volume of local anesthetic in tall patients. 3. Selection of graded dose allows for more predictable and qualitative application of spinal anesthesia during orthopedic and trauma surgeries.

Measurement of the Outcome of Low Dose of 0.5% Bupivacaine Heavy in Spinal Anesthesia during Lower Segment Cesarean Section (LSCS)


 Background: Spinal anesthesia for lower segment cesarean sections is not without its challenges for anesthesiologists, such as severe hypotension from too much bupivacaine or insufficient anesthetic from too little.
 Objective: In this study our main goal is to measure the efficacy of low dose of 0.5% Bupivacaine in spinal anesthesia during lower segment cesarean section.
 Methods: This investigation was conducted at a tertiary medical institution as a cross-sectional comparison study between January 2020 and January 2021, where one hundred pregnant ladies participated.
 Patients who volunteered to take part in the trial were randomly split into two groups: Group A got an intrathecal injection of 3 mL of bupivacaine 0.5% (n=50), while Group B received an intrathecal injection of 2.5 mL of bupivacaine 0.5% (n=50). Tossing a coin was used as a randomizer. The patient's heart rate, blood pressure, and oxygen saturation were taken before receiving anesthesia. Each patient underwent a subarachnoid block (SAB) using a 25-gauge Quincke spinal needle using a midline route after being preloaded with 800 ml to 1000 ml of isotonic intravenous fluid. The entire process of injecting the hyperbaric bupivacaine took no more than twenty to thirty seconds.
 The needle's bevel was aligned with the dura's fibers. All of the data was entered into SPSS-25 after being coded. Statisticians used both descriptive and inferential methods. Percentages, means, standard deviations, graphs, tables, figures, and inferential statistics were all part of the descriptive statistics.
 Results: Most participants were between the ages of 26 and 33, and between 60% and 70% were multiparous over the course of the research.
 In both groups, all patients were able to reach a suitable sensory level for surgical intervention, as shown below. However, ephedrine was advised for 89% of Group B patients to help stabilize their blood pressure, whereas only 19% of Group A patients needed ephedrine. There were no significant variations in fluid consumption (P > 0.05) between Groups A and C (894 126 mL vs. 720 212 mL). The newborn's Apgar score was 9 at 1 minutes and 10 at 5 minutes. Also, although 19% of people in group A reported feeling sick, 23% of people in group B did.
 Conclusion: A lower segment cesarean section performed under an optimal dose of hyperbaric bupivacaine in the spinal anesthesia will produce excellent surgical conditions with little hypotension, in contrast to the low dose. Improved results require more research..

Comparison between two Different Doses of Hyperbaric Bupivacaine in Unilateral Spinal Anesthesia among Geriatric Patients in Hemiarthroplasty Surgery

Comparison between two Different Doses of Hyperbaric Bupivacaine in Unilateral Spinal Anesthesia among Geriatric Patients in Hemiarthroplasty Surgery

Combined spinal-epidural anesthetic management of delivery for marfan syndrome: Case report

Pregnancy in a patient with Marfan syndrome is associated with risks, including cardiovascular complications. The hemodynamic changes of pregnancy during delivery are deleterious to Marfan syndrome patients. This case describes a Marfan syndrome parturient with dilated aortic root >45 mm who underwent neuraxial anesthesia and cesarean delivery. Anesthetic management focused on reducing hypertension and shear forces on the ascending aorta. A combined spinal-epidural with a reduced dose of hyperbaric bupivacaine was utilized for cesarean delivery. Multidisciplinary approaches are vital in the management of Marfan syndrome pregnancy and cardiovascular complications must be considered when planning for delivery and postpartum management. Anesthetic management must consider the hemodynamic changes in pregnancy and severity of Marfan syndrome cardiovascular involvement in the parturient as well as neonatal risks. Guideline development concerning anesthetic management for both the timing of delivery and aortic repair postpartum would be beneficial to Marfan syndrome parturients.

Effect of Hip/Shoulder Width Ratio on the Spread of Spinal Anaesthesia in Term Parturients: A Cross-sectional Study

Introduction: There is increased cephalad spread of spinal anaesthesia with similar dose of hyperbaric bupivacaine in parturients with greater hip width and shorter shoulder width. Aim: To determine the effect of Hip and Shoulder width Ratio (HSR) on the spread of spinal anaesthesia in term parturients. Materials and Methods: The present study was a prospective cross-sectional study conducted in the Department of Anaesthesiology, Regional Institute of Medical Sciences, a tertiary care centre, at Imphal, Manipur, India, from October 2019 to September 2021. A total of 92 parturients aged 18-40 years of age, American Society of Anaesthesiologists (ASA) I and II, undergoing elective caesarean section under subarachnoid block were enrolled. With the parturient in lateral position, a 25G spinal needle was inserted in the L4-L5 interspace. A 2 mL of 0.5% hyperbaric bupivacaine was injected intrathecal in 10 seconds. Age, height, weight, Body Mass Index (BMI), HSR and Vertebral Column Length (VCL) were recorded. Spinal anaesthesia spread was assessed at 0,5,10,15,20,25,30 minutes after the procedure with pin prick test starting from the anaesthetised area and continued cephalad till the sensation changed from the dullness to sharp pain in both the mid-clavicular lines. Results: The mean age, weight, height and BMI were 28.82±6.2 years, 62.36±5.8 kilograms, 158.63±4 centimetre, and 24.77±2 Kg/m2 , respectively. HSR and shoulder width had a significant correlation with the cephalad spread of spinal anaesthesia with r=-0.672 and p-value <0.001 and r=0.369 and p-value <0.001, respectively. Conclusion: HSR and shoulder width has a significant correlation with spread of spinal anaesthesia with a given dose of 0.5% hyperbaric bupivacaine in parturients. The study should expect more cephalad spread of anaesthesia in parturient population when the HSR>1.

Comparison Of Hyperbaric Bupivacaine In Conventional Dose To Isobaric Levobupivacaine Used For Infra Umbilical Surgeries

Background: For spinal anesthesia, levobupivacaine is considered an effective alternative anaesthetic agent to conventional bupivacaineowing to the faster recovery profile and lower probability of cardiovascular toxicity.Aim: To comparatively assess the analgesic and hemodynamic features of conventional dose of hyperbaric bupivacaine to isobariclevobupivacaine used for infra umbilical surgeries.Methods: The present clinical study included 120 subjects from ASA I and ASA II categories presented for elective infra umbilicalsurgeries and were randomly divided into 2 groups of 60 subjects each. Group, I subjects was given 0.5% hyperbaric bupivacaine atthe dose of 3ml, and Group II was given 0.5% isobaric levobupivacaine at the dose of 3ml. Hemodynamic parameters including SpO2,NIBP, and heart rates were assessed every 15 minutes till 2 hours postoperative. Side effects including nausea and vomiting,bradycardia, and hypotension were also evaluated.Results: Sensory block onset was slower in the levobupivacaine group and sensory block levels were comparable. For levobupivacaine,analgesia duration was significantly lower. With levobupivacaine, shorter motor blockade duration and slower motor blockade onsetwere seen. Complete motor blockade was seen in all subjects. Concerning hemodynamic parameters, lesser incidence of bradycardiaand hypotension and high cardiovascular stability. No incidence of PDPH, shivering, nausea, or vomiting was seen in any subject.Conclusion: The present study concludes that significantly similar effects concerning analgesia duration are seen with Bupivacaine aswith levobupivacaine. However, Bupivacaine showed better cardiovascular stability making Levobupivacaine use successful for lowerabdominal surgeries.

The Outcome of Low Dose of 0.5% Bupivacaine in Spinal Anesthesia during Lower Segment Cesarean Section (LUCS)

Background: The spinal anesthesia in a lower segment cesarean section continues to provide a challenge to the anesthetist in the form of either severe hypotension caused by a big bupivacaine dose or insufficient appropriate anesthesia level conditions caused by a little bupivacaine dose. Objective: In this study our main goal is to evaluate the efficacy of low dose of 0.5% Bupivacaine in spinal anesthesia during lower segment cesarean section. Method: This cross sectional comparative study was carried out at tertiary medical College from January 2021 to January 2021. Where a total of 100 pregnant women were included in the study? Patients, who agreed to the study, were randomized divided into two groups: Group A patients who received an intrathecal injection of 3 mL of bupivacaine 0.5%, n=50 and Group B patients who received an intrathecal injection of 2.5 mL of bupivacaine 0.5%, n=50. The method of randomization was by coin tossing. Results: During the study, majority were belonging to 26-33 years age group, 60% and 70% were multiparous. The satisfactory surgical sensory level was achieved in all cases in both groups with the following distribution. However, Only 19% cases in Group A were indicated to have ephedrine, whereas 89% in Group B were indicated to support their blood pressure with ephedrine. There were no differences between the two groups regarding the fluid intake (894 ± 126mL) in Group A versus 720 ± 212 mL in Group C with P > 0.05). Neonatal Apgar score was 9 in the first 1 min and increased to 10 at 5 min. In addition, group A nausea and vomiting cases seen in 19% cases whereas in group B it was 23%. Conclusion: We can say that, unlike low dose, a large dose of hyperbaric bupivacaine in the spinal anesthetic for a lower segment cesarean section will result in excellent surgical circumstances with little hypotension. Further study is needed for better outcome.

Association Between Hyperbaric Bupivacaine Dose and Maternal Hypotension: Retrospective Database Study of 8226 Women Undergoing Cesarean Delivery Under Spinal Anesthesia

(Anesth Analg. 2021;133:967–975) Maternal hypotension is common following an intrathecal hyperbaric bupivacaine dose for cesarean delivery. Studies have varied results or insufficient data when investigating the optimal dose of hyperbaric bupivacaine to reduce the incidence of hypotension. The aim of the study was to determine the relationship between hyperbaric bupivacaine dose and spinal-induced maternal hypotension for women undergoing cesarean delivery.

Predictors of intraoperative pain during cesarean delivery under regional anesthesia

It is unclear why some patients experience pain during cesarean delivery despite receiving appropriate regional anesthesia. Our primary aim was to determine what demographic and clinical variables predict intraoperative pain during cesarean delivery with neuraxial anesthesia. From July 2019 through March 2020, we administered a previously validated patient satisfaction survey to parturients who had a cesarean delivery under regional anesthesia for nonemergent obstetric indications. We performed a post hoc analysis restricted to subjects who had single injection spinal and combined spinal-epidural anesthesia. Parturients who did and did not report pain differed in height, intrathecal hyperbaric bupivacaine dose, and the time from incision to wound closure. We performed an ordinal logistic regression analysis on the 168 subjects with complete data using the aforementioned variables along with the time of day of cesarean delivery. Incision to wound closure time (P < 0.01) predicted intraoperative pain. The multivariate logistic regression model was statistically significant (P < 0.01) and had a receiver operator curve value of 0.74. The duration of time from incision to wound closure predicted intraoperative pain during cesarean delivery under regional anesthesia.

Randomized controlled study comparing a isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries

Levobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. Present study is undertaken to compare hemodynamic and analgesic characteristics using an isobaric levobupivacaine to a conventional dose of hyperbaric bupivacaine for infra umbilical surgeries. A prospective randomized double blind study was conducted involving 60 patients belonging to ASA gr I &amp; II coming for elective lower abdominal surgeries. They were randomly divided into 2 groups of 30 each. Group I received 3ml of 0.5% hyperbaric bupivacaine, group II received 3ml of 0.5% isobaric levobupivacaine. Hemodynamic parameters like heart rate, NIBP and SpO2 were monitored every 15mins till end of surgery and for 2 hours post operatively. Incidence of side effects such as hypotension, bradycardia and nausea and vomiting were noted. Demographic parameters in both groups were comparable. Onset of sensory block was slow in group L . Level of sensory block was comparable and duration of analgesia at L1(L1regression) was significantly shorter with Levobupivacaine compared to Bupivacaine. Onset of motor blockade was slower and duration of motor blockade was also shorter with levobupivacaine compared to bupivacaine. However all the patients in either group attained complete motor blockade.

Effect of encouraging a combined spinal epidural technique for cesarean delivery anesthesia

A combined spinal epidural anesthetic technique allows an anesthesia provider to administer local anesthetic through an epidural catheter in the event of a failed spinal anesthetic. Prior to May 2019, our hospital performed single-shot spinal anesthesia exclusively for cesarean deliveries. In May 2019, anesthesia providers at our hospital were encouraged to perform combined spinal epidural anesthesia for cesarean delivery. We hypothesized that subjects who received combined spinal epidural anesthesia would have superior anesthetic outcomes compared to subjects who received single-shot spinal anesthesia. We performed a retrospective review of subjects who had cesarean deliveries at our hospital from May 15, 2019, through April 15, 2021, who received either single-shot spinal anesthesia or combined spinal epidural anesthesia. Subjects who received combined spinal epidural anesthesia were older, had a higher body mass index, had higher parity, were more likely to have had a cesarean delivery in the past, were more likely to have had the neuraxial anesthetic technique performed by a junior resident, and had a lower intrathecal dose of hyperbaric bupivacaine. Combined spinal epidural anesthesia had similar anesthetic outcomes to single-shot spinal anesthesia for cesarean delivery despite more complex subjects with less experienced operators.

Effect of abdominal girth, vertebral column length, and hip/shoulder width ratio on the spread of spinal anesthesia in term parturients undergoing elective cesarean section: A prospective observational non-randomized study

Background: Spinal anesthesia is the preferred technique for cesarean section, and a suitable level of spinal anesthesia is essential, which may be variable in every parturient. The aim of this study was to evaluate the correlation of abdominal circumference (AC), vertebral column length (VCL), hip shoulder width ratio (HSR), and vertebral column length (VCL)/Abdominal Circumference (AC)2 with the spread of spinal anesthesia in term parturient undergoing elective cesarean section. Methods: Two hundred term parturients undergoing elective cesarean section were enrolled in this prospective observational study. Spinal anesthesia was performed with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine in L2-L3 or L3-L4 interspace using a 25 G Quincke needle. The cephalad spread (loss of pinprick discrimination) was assessed up to 30 minutes after intrathecal injection. Linear regression analysis was used to analyze the relationship between age, weight, height, body mass index (BMI), AC, VCL (C7-Sacral hiatus and C7-iliac crest), HSR, VCL/AC2, and the spread of spinal anesthesia. Results: The maximum sensory level showed a significant correlation with AC (P < 0.001), VCL [C7-SH and C7-IC] (P < 0.039 and P < 0.025) and VCL/AC2 (P < 0.001). Individually, hip width and shoulder width showed a significant correlation with cephalad spread of spinal anesthesia (P < 0.05); however, HSR had no significant correlation with the spread of anesthesia (P > 0.05). Conclusion: AC, VCL, and VCL/AC2 have a significant correlation with cephalad spread of spinal anesthesia when a fixed dose of hyperbaric bupivacaine is used in term parturients undergoing elective cesarean section, while HSR did not show any significant correlation.

Effectiveness of Intrathecal Dexmedetomidine and Fentanyl as Adjuvant to Bupivacaine for Labour Analgesia: A Study Protocol

Background: The most commonly used labour analgesia is epidural. Another alternative method is intrathecal low dose analgesic, given for providing labour analgesia in the areas where the epidural kit, multiparameter monitors, staff members scarcity is present. Fentanyl has been used widely to decrease motor block effect of local anaesthetics during labour, presence of these opioids along with local anaesthetics can cause pruritus and respiratory depression. Selective α2- agonist Dexmedetomidine (DMT) helps in providing stable haemodynamic parameters, and an effective intraoperative and postoperative analgesia. This study aims to compare the effectiveness of an intrathecal analgesia during labor, using bupivacaine in combination with dexmedetomidine and fentanyl in terms of quality and duration of analgesia.&#x0D; Materials and Methods: This will be a prospective comparative observational study. Total 80 patients will be included in the study and assigned to two groups by computerized randomization method. GROUP BD (n=40) will receive an intrathecal 0.5% hyperbaric bupivacaine dose 2.5 mg along with dexmedetomidine dose 2.5 μg .GROUP BF (n=40) will receive an intrathecal 0.5% hyperbaric bupivacaine 2.5mg with fentanyl 25mcg. Data will be analysed and Quality and duration of analgesia will be compared for both groups.&#x0D; Expected Results: Significant difference is expected in labor analgesia and safety profile with the combination of intrathecal bupivacaine and dexmedetomidine compared to combination of bupivacaine and fentanyl.

Способ минимизации типичных осложнений при спинальной анестезии

Целью работы было исследовать влияние низкодозовой спинальной монолатеральной анестезии с использованием гипербарических растворов бупивакаина на кардиогемодинамику, респираторную депрессию, мышечную дрожь, постпункционную головную боль, транзиторный ишемический синдром и потребность в дополнительной внутривенной седации. Низкодозовая спинальная анестезия выявила больший протективный эффект в отношении кардиогемодинамики: стабильное состояние гемодинамики на этапах оперативного лечения при выполнении низкодозовой спинальной монолатеральной анестезии наблюдали в среднем в 3 раза чаще, чем при стандартной спинномозговой анестезии. Использование монолатеральной техники предотвращало опасные изменения респираторной функции на основном этапе в среднем в 2 раза больше, а по окончании операции — в 4 раза. Озноб и дрожь после монолатеральной спинномозговой анестезии наблюдали на основном этапе в 1,5 раза реже, а по окончании оперативного лечения — в 2,4 раза реже, чем при ортодоксальной спинномозговой анестезии.

Sensory block level prediction of spinal anaesthesia with 0.5% hyperbaric bupivacaine: a retrospective study

There is still no consensus on how to determine the dose of spinal anaesthesia with adequate sensory block for a planned surgery. This retrospective study aimed to explore the associations of miscellaneous factors with peak sensory block level after spinal anaesthesia with hyperbaric bupivacaine, and to construct a predictive model for single-shot spinal anaesthesia. We collected the records of 401 non-pregnant adults who underwent spinal anaesthesia with 0.5% hyperbaric bupivacaine at the L3–4 or L4–5 intervertebral space for lower body surgeries. Multiple linear regression analysis was used to investigate predictors of the block level and build up the predictive model. Five variables were identified as independent predictors of the peak sensory block level, including bupivacaine dose, height, weight, gender and age. The predictive model for peak block level after spinal anaesthesia could be expressed as a formula with these five variables and the estimated predictive power was 0.72. Based on this model, it is possible to determine a reasonable dose of hyperbaric bupivacaine for spinal anaesthesia, which gives adequate sensory block required for diverse surgical procedures in various patients and could be considered as a dose reference for sensory block height in spinal anaesthesia.