Low Dose Hyperbaric Bupivacaine Research Articles

Nepalankių kraujotakos reakcijų išsivystymo prognozavimas ir paciento kūno padėties įtaka širdies minutiniam tūriui mažųjų anorektalinių operacijų metu

Tikslas. Nustatyti pradinio širdies minutinio tūrio, matuojamo impedanso kardiografijos metodu, ribą, leidžiančią prognozuoti nepalankių kraujotakos reakcijų, sąlygotų paciento kūno padėties pokyčių, vystymąsi anorektalinių operacijų, atliekamų mažos dozės vietinių anestetikų spinalinėje nejautroje, metu pacientams, sergantiems lydimąja kardiovaskuline patologija.Darbo metodika. Perspektyvusis, stebimasis, klinikinis tyrimas, į kurį įtraukti 48 pacientai, įvertinti ASA 3 funkcinės būklės klase, turintys lydimąją kardiovaskulinę patologiją, stacionarizuoti mažajai anorektalinei operacijai, kuri atlikta mažos vietinių anestetikų dozės spinalinėje nejautroje. Iš jų 3 pacientai į vėlesnį tyrimą neįtraukti dėl įtraukimo kriterijų neatitikimo. Pacientai užklijuotų vokų metodo pagalba, atsitiktine tvarka buvo suskirstyti į dvi grupes: I grupė (n=24), tai pacientai, kuriems operacija atlikta paguldžius į lenktinio peilio padėtį, II grupė (n=24) – pacientai, kuriems operacija atlikta paguldžius į litotomijos padėtį. Operacijos metu buvo stebimi ir registruojami standartiniai rodikliai: širdies susitraukimų dažnis, elektrokardiograma, arterinis kraujo spaudimas bei impedanso kardiografijos parametrai: širdies minutinis tūris, sistolinis tūris, sisteminis kraujagyslių pasipriešinimas. Spinalinė anestezija buvo atlikta sušvirkščiant į subarachnoidinį tarpą 0,8ml (4mg) 0,5proc. hiperbarinio bupivakaino ir 0,2ml (10μg) fentanilo. Rezultatai. Širdies susitraukimų dažnis ir vidurinis arterinis kraujo spaudimas tarp grupių ir grupės viduje nesiskyrė (p>0,05). Širdies minutinis tūris statistiškai reikšmingai sumažėjo nuo pradinio 6,2±1,4 l/min. iki 3,1±0,9 l/min. pacientą paguldžius į lenktinio peilio padėtį ir išliko sumažėjęs operacijos pradžioje (3,0±0,8 l/min.) bei pabaigoje (3,1±0,7 l/ min.). Atitinkamai skirtumas tarp I ir II grupių paguldžius į operacijos padėtį buvo 3,7 l/min., operacijos pradžioje - 3,3 l/min. ir operacijos pabaigoje - 3,1 l/min. (p<0.05). Atlikus diskriminantinę analizę nustatėme, jog pradinė širdies minutinio tūrio riba, kuriai esant tikėtina, kad paguldžius pacientą į lenktinio peilio padėtį širdies minutinis tūris bus mažesnis nei 3,0 l/min., yra <5,94 l/min. Išvados. Lenktinio peilio padėtis anorektalinių operacijų metu veikia širdies minutinio tūrio sumažėjimą. Pacientams, įvertintiems ASA 3 klase dėl kardiovaskulinės patologijos, širdies minutinis tūris sumažės iki < 3,0 l/min., pacientą operacijos metu paguldžius į lenktinio peilio padėtį, esant pradiniam širdies minutiniam tūriui < 5,94 l/min.

Comparative study of two doses of intrathecal dexmedetomidine as adjuvant with low dose hyperbaric bupivacaine in ambulatory perianal surgeries: A prospective randomised controlled study.

Background and Aims:Dexmedetomidine (DMT), as intrathecal adjuvant has been shown to successfully prolong duration of analgesia but delay the motor recovery. Hence, this study was designed to find out the dose of DMT which can provide satisfactory analgesia without prolonging motor block.Methods:A total of 50 patients scheduled for elective perianal surgeries were randomly allocated to Groups C or D (n = 25). Group D received hyperbaric bupivacaine 0.5% 4 mg + DMT 5 μg and Group C received hyperbaric bupivacaine 0.5% 4 mg + DMT 3 μg intrathecally. Onset and duration of sensory and motor blockade, duration of analgesia, time for ambulation and first urination were recorded. Adverse effects if any were noted.Results:Demographic characters, duration of surgery were comparable. The onset of sensory block to S1 was 9.61 ± 5.53 min in Group C compared to 7.69 ± 4.80 min in Group D (P = 0.35). Duration of sensory (145.28 ± 83.17 min – C, 167.85 ± 93.75 min – D, P = 0.5) and motor block (170.53 ± 73.44 min – C, 196.14 ± 84.28 min, P = 0.39) were comparable. Duration of analgesia (337.86 ± 105.11 min – C, 340.78 ± 101.81 min – D, P = 0.9) and time for ambulation (252.46 ± 93.72 min – C, 253.64 ± 88.04 min – D, P = 0.97) were also comparable. One patient in each group had urinary retention requiring catheterization. No other side effects were observed.Conclusion:Intrathecal DMT 3 μg dose does not produce faster ambulation compared to intrathecal DMT 5 μg though it produces comparable duration of analgesia for perianal surgeries.

Effects of ketamine hydrochloride (preservative free) and fentanyl citrate added to low dose hyperbaric bupivacaine for sub-arachnoid block in lower uterine caesarian section – a comperative study

Background Caesarian section is one of the most common operations Now a days for delivery of baby sub-arachnoid block is the better choice. World wide Commonly used bupivacaine with fentanile. Objective The present study was designed to observe the effects of intrathecal ketamine hydrochloride with bupivacaine+complne bupivacaine with fentanyl to observe quality of block eioth duration block during caesarian section. Methods Ninety ASA 1 parturients scheduled for elective caesarian section were randomly selected. There are thirty patients in each group. The base line haemodynamic parameters, heart rate, blood pressure respiratory rate SpO2 and indication of operation were recorded The control group BN (n = 30) received 1.75 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml normal saline intrathecally. While the study group, fentanyl group BF (n = 30) received 1.75 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml (25 mg) injection fentanyl, BK received 1.75 ml of 0.75% hyperbaric bupivacaine plus 0.5 ml (25 mg) of ketamine hydrochloride. Results Duration and quality of sensory and motor block, post-operative analgesia, haemodynamic changes and sedation levels were assessed. There was no significant difference in duration of motor blockade in three groups. Quality of analgesia, sensory block was significant (P<0.05) in BK and BF group than BN group. The quality of block was excellent throughout the surgical procedure in 80% BK group 60% in BF group and 53.3% in control (BN) group. Incidence of hypotension was less in group BF (26.6%) and BK (20%) than group BN (40%). Ketamine had an upper level of sensory block than fentanyl. Conclusion Injection ketamine 25 mg can be used as an adjunct to low dose spinal bupivacaine during caesarian. DOI: http://dx.doi.org/10.3329/jbsa.v24i2.19802 Journal of Bangladesh Society of Anaesthesiologists 2011; 24(2): 53-59

The effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy.

The aim of this study is to examine the effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy. Sixty two patients (ASA I-II) aged 20 to 50 who were planning on undergoing a knee arthroscopy were enrolled in this study. Patients were randomly divided into two groups. Unilateral spinal anaesthesia with 1ml 0.5% hyperbaric bupivacaine was administered to Group B (n=33); and unilateral spinal anaesthesia with 0.5ml (2.5µg) sufentanil added to 1ml hyperbaric bupivacaine was administered to Group BS (n=29). There were no statistically significant differences observed between the groups in terms of demographic data, hemodynamic parameters, maximum sensorial, sympathetic and motor block levels, time to motor block resolution, and time of discharge (p>0.05). There were statistically significant differences between the groups in terms of two segments regression time (Group B=52 min., Group BS=59 min.), ambulation time (Group B=147 min., Group BS=157 min.) and urination time (Group B=136 min., Group BS=149 min.) (p<0.05). In this study, no itching was observed in Group B, whereas seven patients in Group BS were observed as having postoperative itching (p<0.05). All patients were successfully given unilateral spinal anaesthesia with sufentanil added to low-dose hyperbaric bupivacaine for an outpatient knee arthroscopy, without affecting the time of discharge. However, for one-day interventions such as arthroscopy, it was concluded that administration of only low-dose hyperbaric bupivacaine was sufficient.

A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial.

Background:The thoracic spinal anesthesia was first described in 1909 and recently revised for various surgical procedures. This is a prospective study aims to evaluate the parameters of the thoracic spinal anesthesia (latency, motor block and paresthesia), the incidence of cardiovascular changes and complications comparing low doses of isobaric and hyperbaric bupivacaine.Materials and Methods:A total of 200 orthopedic patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T9-T10, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with 0.5% bupivacaine isobaric or hyperbaric. Patients remained in cephalad or head down position 10-20° for 10 minutes. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications.Results:All patients developed spinal and there was no failure. The solution did not affect the onset of the blockade. The duration of motor block was greater than the sensitive with isobaric. The duration of sensory block was greater than the motor block with hyperbaric solution. The incidence of paresthesia was 4%, with no difference between the needles. The incidence of hypotension was 12.5% with no difference between the solutions. There was no neurological damage in all patients.Conclusion:The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery

Efficacy of low dose hyperbaric bupivacaine in spinal anaesthesia for LUCS

Spinal Anaesthesia (SAB) is a popular anaesthetic technique in LUCS. SAB is performed in sitting and lateral position. The aim of this study is to explore the efficacy of spinal anaesthesia ie, height of block and haemodynamic changes with low dose hyperbaric bupivacaine in different position in LUCS. Total 80 of ASA grade I &amp; II elective LUCS patient preloaded with 800-1000 ml of isotonic fluid were allocated randomly to receive different doses (10 mg, 12 mg,) of 5% Hyperbaric bupivacaine at L4-L5 interspaces in sitting (S group) and in lateral (L group) position to compare the height of block and haemodynamic changes. In sitting position in 10 mg dose group (S 10) adequate block developed in 7 patients out of 20 (35%) with no fall of systolic BP, in 12 mg dose group (S12) adequate block developed in 14 patients out of 20 (70%) with fall of systolic BP&gt;1/3rd in 2 patients (10%). In lateral position groups (L group) with 10 mg dose ((L 10 group), 17 patients out of 20 got adequate block (85%) with fall of systolic BP&gt;1/3rd in 2 patients out of 20 (10%) and in 12 mg dose group (L 12) adequate block in 20 patients out of 20 (100%) with fall of systolic BP&gt;1/3rd in 5 patients out of 20 (25%). So block height with low dose of Hyperbaric Bupivacaine for caesarean section is more predictable and haemodynamically stable in lateral position DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13624 Bang Med J (Khulna) 2012; 45 : 15-18

Comparative Evaluation Of Low Dose Hyperbaric Bupivacaine With Or Without Fentanyl In Spinal Anaesthesia For Caesarean Section In Patients With Pregnancy Induced Hypertension

Comparative Evaluation Of Low Dose Hyperbaric Bupivacaine With Or Without Fentanyl In Spinal Anaesthesia For Caesarean Section In Patients With Pregnancy Induced Hypertension

Subarachnoid clonidine or fentanyl with low dose hyperbaric bupivacaine for elective caesarean section - A comparative study

Background: Preferred technique of anaesthesia for caesarean section is neuraxial block. Hyperbaric bupivacaine in adequate dose for subarachnoid block often causes complications like hypotension, shivering, nausea, vomiting, chest pain and epigastric pain. Objectives: The aim of study is to reduce the complications of subarachnoid block, improve quality of block, quality of anesthesia, prolong duration of post operative analgesia by reducing total dose of local anaesthetics with the use of adjuvant like fentanyl or clonidine. Methods: Ninety parturients of ASA grade I &amp; II for caesarean section under subarachnoid block were randomly allocated equally into three groups: Group B: hyperbaric bupivacaine 0.5% of 2 ml+ 0.25ml normal saline regarded as controlGroup BC: hyperbaric bupivacaine 0.5% of 1.75 ml + 0.5 ml clonidine (75 ?g)Group BF: hyperbaric bupivacaine 0.5% of 1.75 ml + 0.5 ml fentanyl (25 ?g) Parametric data like pulse, blood pressure among the groups were analyzed by ANOVA test &amp; nonparametric data like chest discomfort, epigastric pain, nausea, vomiting were analyzed by chi-square test. Results: The study revealed that subarachnoid clonidine or fentanyl as adjuvant with low dose hyperbaric bupivacaine provide better quality of block, better quality of anaesthesia,more haemodynamical stability and longer duration of post operative analgesia compared to bupivacaine alone.Clonidine is better alternative to fentanyl as adjuvant with bupivacine in subarachnoid block. Conclusion: Addition of clonidine as adjuvant can reduce total dose of bupivacaine in subarachnoid block to ensure better quality of block, better quality of anaesthesia by reducing complications and longer duration of post operative analgesia compared to fentanyl. DOI: http://dx.doi.org/10.3329/jdnmch.v17i1.12185 J. Dhaka National Med. Coll. Hos. 2011; 17 (01): 14-17

Comparative Evaluation of Low dose Hyperbaric Bupivacaine with or without Fentanyl in Spinal Anaesthesia for Caesarean Section in patients with Pregnancy Induced Hypertension

Neuraxial administration of opioid’s along with local anesthetics improve the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration. The present study was conducted to study and compare the effects of bupivacaine alone and its combination with fentanyl used intrathecally in parturients with PIH. 50 ASA grade II patients with PIH defined as blood pressure between 140-160/ 90-110 mmHg without proteinuria were selected and divided into 2 groups as Group (I)-Bupivacaine and Group (II)BupivacaineFentanyl group. Haemodynamic variables like systolic and diastolic blood pressure, heart rate were recorded every 2 minutes upto delivery of baby and then every 5 minutes until end of surgery. Sensory block and motor block alongwith side effects were recorded. Pain was evaluated using visual analogue scale and neonatal outcome assessed using APGAR scoring. The highest sensory level achieved in bupivacaine-fentanyl group was higher than in the group receiving plain bupivacaine. The time taken for sensory regression to T12 and duration of analgesia was longer in the Bupivacaine-Fentanyl group. We conclude the combination group prolongs the duration of sensory spinal block, increases the duration of analgesia without increasing the duration of motor block, does not cause any significant side effects and provides stable haemodynamic conditions without fetal or maternal compromise.

Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine.

BackgroundLaparoscopic cholecystectomy has the advantages of causing less postoperative pain and requiring a short hospital stay, and therefore is the treatment of choice for cholelithiasis. This study was designed to compare spinal anesthesia using hyperbaric bupivacaine given as a conventional dose by lumbar puncture or as a low-dose by thoracic puncture.MethodsA total of 140 patients with symptomatic gallstone disease were randomized to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia using either conventional lumbar spinal anesthesia (hyperbaric bupivacaine 15 mg and fentanyl 20 mg) or low-dose thoracic spinal anesthesia (hyperbaric bupivacaine 7.5 mg and fentanyl 20 μg). Intraoperative parameters, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two treatment groups.ResultsAll procedures were completed under spinal anesthesia, with no cases needing conversion to general anesthesia. Values for time for block to reach the T3 dermatomal level, duration of motor and sensory block, and hypotensive events were significantly lower with low-dose bupivacaine. Postoperative pain was higher for low-dose hyperbaric bupivacaine at 6 and 12 hours. All patients were discharged after 24 hours. Follow-up 1 week postoperatively showed all patients to be satisfied and to be keen advocates of spinal anesthesia.ConclusionLaparoscopic cholecystectomy can be performed successfully under spinal anesthesia. A small dose of hyperbaric bupivacaine 7.5 mg and 20 μg fentanyl provides adequate spinal anesthesia for laparoscopy and, in comparison with hyperbaric bupivacaine 15% and fentanyl 20 μg, causes markedly less hypotension. The low-dose strategy may have an advantage in ambulatory patients because of the earlier recovery of motor and sensory function and earlier discharge.

The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section

The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fixed dose during caesarean section. A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5%) according to the height and weight of patients (Group AD) from Harten's dose chart developed from the Caucasian parturients and the fixed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a significantly (p < 0.05) larger number of patients 12 (24%) in Group FD than in one (2%) patient in Group AD. A significantly (p < 0.05) larger number of patients, 32, (64%) in Group FD had hypotension than in 15 (30%) patients in Group AD. The lowest recorded SAP (101 +/- 6 mm Hg) in Group AD was higher than in Group FD (96 +/- 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. The bupivacaine dose was significantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fixed compared with the dose use.

Unilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine–clonidine combination

Low-dose hyperbaric bupivacaine has been used to produce unilateral spinal anaesthesia for outpatient surgery. Unilateral spinal anaesthesia is associated with reduction of hypotension, faster recovery and increased patient satisfaction. Small doses of clonidine have shown effectiveness in intensifying spinal anaesthesia. We investigated the effect of adding 15 microg of clonidine to 5 mg hyperbaric bupivacaine on unilaterality. Sixty patients undergoing outpatient knee arthroscopy were randomly allocated to receive either 1.2 ml (6 mg) of hyperbaric bupivacaine or a 1.2 ml solution containing 1.0 ml (5 mg) hyperbaric bupivacaine, 0.1 ml (75 microg) clonidine and 0.1 ml sterile water. The motor block was assessed by a modified Bromage scale and the sensory block by a pinprick. There was a significant difference in the spread of anaesthesia between the operated and contralateral sides in both groups. Seventy-seven per cent of the blocks were unilateral in group B and 73% in group B-C. There was no significant difference between the groups, in unilaterality. The motor block was prolonged in group B-C but it did not affect home-readiness. Patients receiving clonidine needed more vasopressors. There was a significant difference in blood pressures between the groups, being lower in group B-C after 1 h 45 min. Using 5 mg hyperbaric bupivacaine with 15 microg of clonidine, the unilaterality can be achieved and spinal anaesthesia intensified without affecting home-readiness. More vasopressors are needed in the beginning, but after the surgery patients experienced less pain.

319: Single shot spinal anaesthesia with low dose hyperbaric bupivacaine (3.75 mg), for hip fracture repair surgery in the elderly

319: Single shot spinal anaesthesia with low dose hyperbaric bupivacaine (3.75 mg), for hip fracture repair surgery in the elderly

Single shot spinal anaesthesia with low dose hyperbaric bupivacaine (3.75 mg), for hip fracture repair surgery in the elderly

Single shot spinal anaesthesia with low dose hyperbaric bupivacaine (3.75 mg), for hip fracture repair surgery in the elderly

Caudal and low-dose hyperbaric bupivacaine spinal blockade for adult anorectal surgery: a double-blinded randomized controlled study

Caudal and low-dose hyperbaric bupivacaine spinal blockade for adult anorectal surgery: a double-blinded randomized controlled study

The Characteristics of Clinical Anesthesia Based on the Duration of Lateral Decubitus in Low Dose Hyperbaric Bupivacaine Induced Unilateral Spinal Block

Background: When attempting a unilateral spinal anesthesia, many factors must be considered including patient's position, density and amount of the local anesthetics, needle design, injection speed. We evaluated a duration of lateral decubitus with low dose hyperbaric bupivacaine for maximizing the benefit. Methods: Hyperbaric 0.5% bupivacaine 6 mg was administered slowly through a 25-gauge Whitacre needle to 60 ASA 1-2 patients undergoing unilateral lower extremity surgery. The patients were randomly allocated to four groups based on the duration of lateral decubitus after spinal anesthesia: 5 minutes in Group I; 10 minutes in Group II; 15 minutes in Group III; 20 minutes in Group IV. Circulatory variables, sensory and motor block level were recorded. Results: The circulatory variables were stable in all patients. In the Group I, the success rate of unilateral motor block was significantly lower than other groups. In the Group IV, the success rate of unilateral sensory block was significantly higher than group I. In the Group II, III, IV, the patient's satisfaction scores were significantly higher than Group I. Conclusions: When unilateral spinal anesthesia was attempted with 0.5% hyperbaric bupivacaine 6 mg, cardiovascular stability was achieved in the groups that patients are kept in a lateral decubitus for more than 5 minutes after spinal injection, and patient's higher satisfaction scores were achieved in the unilateral motor block and in the groups that patients are kept in a lateral decubitus for more than 15 minutes after spinal injection.

Home readiness after spinal anaesthesia with low-dose hyperbaric bupivacaine 0.5%

Home readiness after spinal anaesthesia with low-dose hyperbaric bupivacaine 0.5%