Hyperbaric Bupivacaine Solution Research Articles

Comparison of a fixed dose of 0.15% Hypobaric and 0.5% Hyperbaric Bupivacaine for shortterm unilateral lower limb orthopedic surgeries.Retrospective study with two videos

Background: Unilateral spinal anesthesia in orthopedic surgery of a limb has its advantages, especially in patients undergoing outpatient basis surgeries. Low dose, slow speed of administration and remaining in lateral decubitus for a certain period facilitate unilateral distribution in spinal anesthesia. Isobaric solutions of local anesthetics are not suitable for this type of anesthesia. Hypobaric and hyperbaric solutions of bupivacaine were compared in unilateral spinal anesthesia in patients undergoing orthopedic surgeries of one limb on an outpatient basis. Methods: Retrospective study carried out between 2002 and 2020 with 497 patients were randomly divided into two groups to receive 6 mg of 0.15% hypobaric bupivacaine or 6 mg of 0.5% hyperbaric bupivacaine. The solutions were administered in the L3-L4 space with the patient in the left lateral decubitus and remaining in this position for 15 minutes. Sensitive anesthesia was evaluated by the pin prick test. Motor blockade was determined by the modified Bromage scale. Both blockades were compared with the opposite side and among themselves. Results: There was a significant difference between the side of the surgery and the opposite side in all two groups at 15 minutes, but the frequency of unilateral spinal anesthesia was 90.9% with the 0.15% hypobaric bupivacaine versus 93.2% with the 0.5% hyperbaric bupivacaine. Patients did not develop any hemodynamic changes. Post puncture headache and transitory neurological symptoms were not observed. Conclusion: Spinal anesthesia with hypobaric and hyperbaric solutions present a higher frequency of unilateral anesthesia, without cardiocirculatory alteration, and patient satisfaction in remaining with a limb without anesthesia.

COMPARISON OF HAEMODYNAMIC STABILITY WITH 0.5% AND 0.75% HYPERBARIC BUPIVACAINE DURING SPINAL ANAESTHESIA IN WOMEN UNDERGOING CAESAREAN SECTION

Objective: To compare the effect of 0.5% and 0.75% hyperbaric Bupivacaine on haemodynamic stability in terms of mean systolic blood pressure and heart rate recorded at 4 min in patients undergoing caesarian section in spinal anesthesia.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Malir, from Jul to Dec 2018.
 Methodology: The patients were assigned in two groups (A and B) using lottery method. Group A received 0.5% hyperbaric Bupivacaine solution. Group B received 0.5% hyperbaric Bupivacaine solution. Spinal anaesthesia was given, blood pressure and heart rate were recorded. Data were analyzed in SPSS version 23. Both groups were compared for mean systolic blood pressure and heart rate by using independent sample t-test.
 Results: The mean age of patients was 29.62 ± 6.21 years in 0.75% Bupivacaine group while 29.31 ± 6.20 years in 0.5% Bupivacaine group. The mean systolic blood pressure of patients was 111.63 ± 5.96 mmHg in 0.75% Bupivacaine group while 117.16 ± 7.12 mmHg in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05). The mean heart rate of patients was 92.27 ± 4.71 beats per min (bpm) in 0.75% Bupivacaine group while 97.68 ± 4.58 bpm in 0.5% Bupivacaine group. The difference was significant in both groups (p-value <0.05).
 Conclusion: 0.5% hyperbaric Bupivacaine was better than 0.75% hyperbaric Bupivacaine solution in spinal anaesthesia during caesarean section.

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.

A comparative study of 0.5% hyperbaric Ropivacaine versus 0.5% hyperbaric Bupivacaine for spinal anaesthesia

Aims and Objective: Aim of the present study was to compare the clinical efficacy of 0.5% hyperbaric solutions of ropivacaine versus bupivacaine in terms of characteristics of spinal blockade, haemodynamic stability, recovery profile and side effects. Material and Method: The study enrolling 100 patients (age 20-60 years) of either sex, ASA grade I & II were randomly allocated in two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine with glucose 8.33% and Group B received 3 ml of 0.5% hyperbaric bupivacaine with glucose 8%. After induction, we studied the various parameters of subarachnoid block, hemodynamic variables, recovery and side effects. Result: Hyperbaric ropivacaine had late onset of sensory blockade, equal time to reach maximum dermatome level, early regression and shorter total duration of sensory blockade as compared to bupivacaine. Ropivacaine shows late onset of motor blockade, less degree and total duration of motor blockade as compared to bupivacaine. Ropivacaine was more hemodynamically stable as compared to bupivacaine. Both the sensory and motor blocks were subject to a more rapid recovery with ropivacaine compared with bupivacaine. Hyperbaric ropivacaine was not associated with any side effects intra and postoperatively. Conclusion: 3 ml of hyperbaric solution of ropivacaine 0.5% with glucose 8.33% can produce predictable and reliable spinal anaesthesia for a wide range of surgical procedure.

Spinal Anaesthesia With Low-dose Bupivacaine in Marginally Hyperbaric Solutions for Caesarean Section: A Randomized-Controlled Trial

(Eur J Anaesthesiol. 2015;32(7):493–498) Studies involving spinal anesthesia in nonobstetric situations have demonstrated that marginally hyperbaric bupivacaine solutions (containing ≤0.8% glucose but still denser than cerebrospinal fluid) produce a more consistent block albeit a lower sensory level than the conventional hyperbaric solution containing 8% glucose. The marginally hyperbaric solution has also been found to have a lower rate of hypotension in the nonobstetric setting. However, the efficacy of spinal anesthesia with marginally hyperbaric low-dose bupivacaine has not been studied during cesarean section (CS). This randomized, controlled trial compared the efficacy of 3 different marginally hyperbaric solutions of low-dose (7.2 mg) bupivacaine with that of the conventional hyperbaric solution in women undergoing elective CS The investigators hypothesized that the marginally hyperbaric low-dose bupivacaine solutions would be associated with a reduced cephalad spread and a reduced incidence of side effects compared with the conventional hyperbaric solution.

Effect of granisetron in attenuation of hypotension following spinal anaesthesia in parturients undergoing elective caesarean section - a double blind randomized controlled trial

Background: Spinal anaesthesia has side effects like hypotension and bradycardia, which may be induced by sympathetic blockade and Bezold-Jarisch reflex (mediated by peripheral serotonin receptor, 5-HT3 type). The objective of the study was to evaluate the effects of type 3 serotonin receptors blockade by intravenous granisetron pre-treatment in spinal induced hypotension in parturient undergoing elective caesarean section.Methods: Fifty six parturient with American Society of Anaesthesiologists Physical Status I and II undergoing elective caesarean section were assigned randomly to receive either Normal Saline (control) or Granisetron 1mg intravenously five minutes before spinal anaesthesia. Spinal anaesthesia was performed with 2.2 ml 0.5% hyperbaric bupivacaine solution and then heart rates, systolic blood pressure, diastolic blood pressure, mean arterial pressure were recorded every two and half minutes for ten minutes and then every five minutes for till end of surgery after. Hemodynamic parameters were compared with baseline in each group.Results: Change in mean, systolic and diastolic arterial pressure compared with baseline value were comparable in both the groups, but use of ephedrine as rescue vasopressor drug was significantly reduced in granisetron group. The episodes of hypotension, nausea/vomiting and shivering were comparable in both groups.Conclusions: Type 3 serotonin blockade by intravenous granisetron pre-treatment does not reduce spinal induced hypotension in parturient undergoing elective caesarean section; however there is reduction in need of rescue vasopressor.

Hemodynamic Changes During Spinal Anesthesia For Elective Cesarean Section With Hyperbaric Bupivacaine: Effect Of Volume And Concentration

Background: Spinal anesthesia for cesarean section with hyperbaric Bupivacaine is widely used. The course of the procedure is frequently troubled by hemodynamic instability that is determined by the level of spinal block and this in turn depends on the spread of the local anesthetic within the CSF. By fixing the dose of the local anesthetic any increase in its volume leads to a decrease in its concentration because these factors are closely related to each other and they can affect the spread of the local anesthetic. Objective: To compare between large volume but lower concentration (4 ml of 0.25%) and small volume but higher concentration (2 ml of 0.5% ) of hyperbaric Bupivacaine solutions used for spinal anesthesia for elective cesarean section in respect to hemodynamic changes. Method: A clinical interventional study was Performed at Al-Zahra'a Teaching Hospital (Najaf ) of 18th Jun.-18th Jul. 2013. Forty patients scheduled for elective cesarean section were randomly selected and randomly divided into two equal groups (A and B). Both groups received hyperbaric Bupivacaine via intrathecal route, group (A) received 4 ml of 0.25% solution while group (B) received 2 ml of 0.5% solution. Hemodynamic variables (blood pressure and heart rate) were recorded throughout the time of anesthesia. Data was analyzed by using SPSS version 20. Results: There was no significant difference in the incidence of hypotension (P value=1.0) between the two groups while the incidence of bradycardia was equal between the two groups (10%) but there was a need for significantly higher average dose of Ephedrine that was used to treat hypotension in group (A) than in group (B) (P value=0.49%) reflecting more severe hypotension in group (A) than group (B). Conclusion: we conclude that the volume factor has more influence than the concentration on blood pressure with regard to hyperbaric intrathecal Bupivacaine solutions used for elective cesarean section. Recommendation: the use of smaller volume but higher concentration of intrathecal Bupivacaine is advisable in elective cesarean section.

Non-invasive haemodynamic measurements with Nexfin predict the risk of hypotension following spinal anaesthesia.

Unfavourable circulatory system conditions have been observed in many patients with spinal anaesthesia. The most frequent symptoms include a decrease in blood pressure and, less frequently, bradycardia. The appearance of unfavourable consequences of spinal anaesthesia might be related to the initial status of the patient's circulatory system. The aim of this study was to establish the possibility of predicting unfavourable circulatory consequences (hypotension, bradycardia) following spinal anaesthesia, based on non-invasive haemodynamic assessment with a Nexfin device. This prospective study included 100 18-60-year-old ASA I or II planned spinal anaesthesia patients. The initial hemodynamic parameters were assessed with a Nexfin monitor. Anaesthesia was performed with 3-3.5 mL of a 0,5% hyperbaric bupivacaine solution. Within 20 min after the administration of anaesthesia, the arterial blood pressure values, heart rate, sensory blockade level, and motoric blockade level were recorded in 5-min intervals. Hypotension was classified by a decrease of SAP < 90 mm Hg and/or the decrease of the SAP ≥ 20% initial value. Logistic regression was used to determine the independent predictors of hypotension resulting from a spinal blockade. The development of hypotension and bradycardia was observed in 39 and 2%, respectively, of the patients. The patients who developed hypotension differed significantly from those who did not develop this symptom, with the main difference being the body mass and the assessment on the ASA scale. The patients who developed hypotension after spinal anaesthesia differed significantly in the initial hemodynamic parameters (SAP, MAP, SVRI). The following two independent risk factors for hypotension were isolated: the mean arterial pressure (OR 1.04; 95% CI: 1.005-1.076) and the systemic vascular resistance index (OR 1.109; 95% CI: 1.021-1.204). Nexfin-based non-invasive haemodynamic monitoring might be helpful in the identification of individuals with a high risk of hypotension following spinal blockade.

Spinal anaesthesia with low-dose bupivacaine in marginally hyperbaric solutions for caesarean section: A randomised controlled trial.

Conventional hyperbaric spinal anaesthesia solution (SAS) with 8% glucose and low-dose bupivacaine may reduce the incidence of hypotension in caesarean section compared to standard doses, and marginally hyperbaric SAS (≤0.8% glucose) can induce a lower block level and a lower incidence of hypotension in nonobstetric patients than conventional 8% glucose SAS. The objective of this study was to evaluate the clinical efficacy of marginally hyperbaric low-dose bupivacaine solutions used for spinal anaesthesia during caesarean section. A randomised, controlled clinical trial. Single medical centre. One hundred twenty women scheduled for elective caesarean section were randomised into four groups. Caesarean section after combined spinal-epidural anaesthesia using hyperbaric preparations of low-dose SAS (7.2 mg bupivacaine and 2 μg 1.6 ml sufentanil in one of the following: 8%, 0.8%, 0.5% or 0.33% glucose solution. The dermatomal sensory block and degree of motor block of the lower extremities and adverse effects of anaesthesia were recorded. The maximum cephalad sensory block level and the incidence of hypotension decreased as the density of SAS fell (T1, T2, T4 and T6, P < 0.001; 48.3, 30, 13.3 and 10.3%, P = 0.003). The incidence of shivering reduced with decreasing density of SAS (P < 0.05). There was no significant difference in the quality of anaesthesia (efficacy of motor block and sensory block) between the groups (P > 0.05). Compared with conventional 8% glucose hyperbaric SAS, marginally hyperbaric (0.5 or 0.33% glucose) low-dose bupivacaine solutions led to a significantly lower height of cephalad spread and incidence of hypotension with no impact on the efficacy of spinal anaesthesia for caesarean section.

The effects of subarachnoid administration of hyperbaric solutions of bupivacaine or ropivacaine in xylazine-sedated calves undergoing surgery

The aim of this study was to compare the effects of subarachnoid administration of hyperbaric solutions of bupivacaine or ropivacaine in xylazine-sedated calves undergoing surgery. Subarachnoid anaesthesia was performed with...

Is It Useful and Safe to Maintain the Sitting Position During Only One Minute before Position Change to the Jack-knife Position?

BackgroundConventional spinal saddle block is performed with the patient in a sitting position, keeping the patient sitting for between 3 to 10 min after injection of a drug. This amount of time, however, is long enough to cause prolonged postoperative urinary retention. The trend in this block is to lower the dose of local anesthetics, providing a selective segmental block; however, an optimal dose and method are needed for adequate anesthesia in variable situations. Therefore, in this study, we evaluated the question of whether only 1 min of sitting after drug injection would be sufficient and safe for minor anorectal surgery.MethodsTwo hundred and sixteen patients undergoing minor anorectal surgery under spinal anesthesia remained sitting for 1 min after completion of subarachnoid administration of 1 ml of a 0.5% hyperbaric bupivacaine solution (5 mg). They were then placed in the jack-knife position. After surgery, analgesia levels were assessed using loss of cold sensation in the supine position. The next day, urination and 11-point numeric rating scale (NRS) for postoperative pain were assessed.ResultsNone of the patients required additional analgesics during surgical manipulation. Postoperative sensory levels were T10 [T8-T12] in patients, and no significant differences were observed between sex (P = 0.857), height (P = 0.065), obesity (P = 0.873), or age (P = 0.138). Urinary retention developed in only 7 patients (3.2%). In this group, NRS was 5.0 ± 2.4 (P = 0.014).ConclusionsThe one-minute sitting position for spinal saddle block before the jack-knife position is a safe method for use with minor anorectal surgery and can reduce development of postoperative urinary retention.

Intrathecal hyperbaric or isobaric bupivacaine and ropivacaine with fentanyl for elective caesarean section

Objective. We aimed to investigate the efficacy of either plain or hyperbaric solutions of intrathecal bupivacaine and ropivacaine on maternal block characteristics, complications, side effects and neonatal parameters to find out which is superior in a single study.Methods. One hundred and three term parturients were randomly assigned to receive intrathecal 10 mg hyperbaric bupivacaine (Group Bh), 10 mg plain bupivacaine (Group Bp), 15 mg hyperbaric ropivacaine prepared with dextrose 30% (Group Rh) or 15 mg plain ropivacaine (Group Rp) coadministered with fentanyl 20 μg. Sensory and motor block characteristics, analgesia duration, ephedrine consumption, and neonatal and maternal parameters were recorded.Results. Time to maximum cephalad spread of sensory block was longer in Group Rp than both bupivacaine groups. Time to achieve sensory block at T6 dermatome was similar between both hyperbaric groups (Group Bh:4.5 ± 1.6, Group Rh:4.6 ± 1.1, p > 0.05) but Group Rp needed significantly longer time (7.5 ± 5.5 min, p = 0.003) than both hyperbaric groups. Duration of motor block was shorter in ropivacaine groups (Group Rh: 90.6 ± 17.3, Group Rp 121.6 ± 33.7) vs. bupivacaine groups (Group Bh: 140.2 ± 33.3, Group Bp: 149.7 ± 46.0); Group Rh being shorter than Group Rp (p < 0.05). Ephedrine consumption was less in Groups Rh (20.0 ± 11.9 mg) and Rp (18.3 ± 12.4 mg) vs. Groups Bh (30.0 ± 14.9 mg) and Bp (27.8 ± 15.4 mg) (p = 0.006).Conclusions. Intrathecal hyperbaric ropivacaine 15 mg with fentanyl 20 μg for CSE is suitable since it provides early motor recovery leading to faster patient ambulation, rapid onset of sensory block with less ephedrine.

Büyük Ortopedik Cerrahi Girişimlerde Hiperbarik Ropivakain, Levobupivakain ya da Bupivakain Çözeltileri ile Uygulanan Spinal Anestezi

Büyük Ortopedik Cerrahi Girişimlerde Hiperbarik Ropivakain, Levobupivakain ya da Bupivakain Çözeltileri ile Uygulanan Spinal Anestezi

Spinal anesthesia with 3.75 mg of 0.25% hyperbaric bupivacaine for diabetic foot surgery.

Spinal anesthesia in the sitting position with low-dose local anesthetics usually provides satisfactory anesthesia for diabetic foot surgery because most operations do not require tourniquet application. This study was designed to investigate the influence of different sitting periods after subarachnoid injection of low dose bupivacaine on the spread of analgesia. In this randomized, controlled clinical trial, 60 patients undergoing diabetic foot surgery under spinal anesthesia without a tourniquet were randomized to three groups. Patients remained sitting for 2 (Group D2, n = 20), 5 (Group D5, n = 20), or 10 (Group D10, n = 20) min after the completion of subarachnoid administration of 3.75 mg of 0.25% hyperbaric bupivacaine solution. They were then placed in the supine position. Analgesia levels were assessed bilaterally using pinpricks. Blood pressure and heart rate were also recorded. The maximal sensory block level [median (range)] was higher in Group D2 [L3 (L2-L3)] compared with Group D10 [L4 (L3-L4)] (P = 0.002). The highest sensory block levels were T12, T11, and L2 in Group D2, 5 and 10, respectively. There were no hemodynamic differences among the three groups and none of the patients showed hemodynamic instability except for one patient in Group D10. Although spinal anesthesia using a minimal dose of 0.25% hyperbaric bupivacaine provides adequate anesthesia for diabetic foot surgery without profound hypotension, regardless of the time spent in the sitting position, maintaining the position for 10 min required to confine the sensory blockade on the lower level.

Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine

BackgroundThe aim of this study was to compare the clinical effects of ‘hyperbaric’ bupivacaine for spinal anaesthesia with those of similar preparations of levobupivacaine and ropivacaine. MethodsSixty ASA grade I–II patients undergoing elective surgery under spinal anaesthesia were randomized to receive 3 ml of bupivacaine, levobupivacaine, or ropivacaine, each at 5 mg ml−1 and made hyperbaric by the addition of glucose 30 mg ml−1. A standard protocol was followed after which a blinded observer assessed the sensory and motor blocks. The level and duration of sensory (pinprick) block, intensity and duration of motor block, and time to mobilize and to micturate were also recorded. ResultsOne patient (ropivacaine group) required general anaesthesia because of technical failure, but all the other blocks were adequate. There were no significant differences between the groups with regard to the mean time to onset of sensory block at T10, the extent of spread, or mean time to maximum spread. Regression of sensory block in the ropivacaine group was more rapid as demonstrated by duration at T10 (P<0.0167) and total duration of sensory block (P<0.0167). Patients in the ropivacaine group had more rapid recovery from motor block (P<0.0167) and shorter times to independent mobilization (P<0.0167). There were no significant differences between the bupivacaine and the levobupivacaine groups. Conclusions‘Hyperbaric’ ropivacaine provides reliable spinal anaesthesia of shorter duration than bupivacaine or levobupivacaine, both of which are clinically indistinguishable. The recovery profile of ropivacaine may be useful where prompt mobilization is required.

Comparison of hyperbaric solutions of ropivacaine, levobupivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

Comparison of hyperbaric solutions of ropivacaine, levobupivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

183: Comparison of hyperbaric solutions of ropivacaine, levobupivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

183: Comparison of hyperbaric solutions of ropivacaine, levobupivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

160: Comparison of plain and hyperbaric solutions of ropivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

160: Comparison of plain and hyperbaric solutions of ropivacaine and bupivacaine for spinal anesthesia for major orthopedic surgery

Combined spinal and epidural anesthesia for lower extremity surgery: minimum dose of hyperbaric bupivacaine solution during spinal anesthesia for geriatric patients

Combined spinal and epidural anesthesia for lower extremity surgery: minimum dose of hyperbaric bupivacaine solution during spinal anesthesia for geriatric patients

Treatment of Pain and Stress in the Neonate

After completing this article, readers should be able to: 1. Describe the pain assessment tools used for preterm and term neonates. 2. List painful procedures in the neonatal intensive care unit (NICU). 3. Describe nonpharmacologic interventions for alleviating neonatal pain. 4. Describe pharmacologic methods used for neonatal analgesia. 5. Delineate the adverse effects of the common forms of pain relief. Neonates are sensitive to pain and vulnerable to both its short- and long-term effects. However, there is a lack of consistency in both attitudes and practices among NICU staff with regard to pain assessment and management in neonates. Recognition of the clinical importance of neonatal pain and stress has been delayed and hampered by the lack of awareness that newborns are capable of experiencing pain, insufficient knowledge about the developing nervous system, difficulty in assessing neonatal pain, lack of evidence for the safety and efficacy of different modalities available for the treatment of pain, and fears about adverse effects associated with analgesic use. Neonatal pain has been of minimal concern until the last 25 years. For example, at one time, neonates were given paralytic drugs without anesthesia for major surgical procedures because physicians believed that neonates were incapable of interpreting or remembering pain. Further, there was no understanding of the consequences of untreated pain. Newer technologies to sustain life have exposed neonates to multiple invasive procedures and prolonged hospital stays that are associated with acute and chronic pain and stress. In 2001, an international evidence-based group for neonatal pain developed guidelines for the assessment, prevention, and treatment of neonatal pain in an effort to standardize practices for physicians and health care facilities. Within the consensus statement, the group defined general principles to prevent and treat pain and listed the most commonly performed diagnostic, therapeutic, and surgical procedures in the NICU. The guidelines also indicated the …