Mg Of Plain Bupivacaine Research Articles

Fentanyl with low dose bupivacaine (isobaric and hyperbaric) and levobupivacaine for combined spinal-epidural technique in cesarean section

To compare the hemodynamic and motor block effects of fentanyl combined with low doses of isobaric and hyperbaric bupivacaine and isobaric levobupivacaine in Caesarean operations with Combined Spinal-Epidural Anesthesia (CSEA) method. The aim of study is to use levobupivacaine and bupivacaine more effectively and comfortably in caesarean sections. Methods: A hundred and sixty pregnant women were randomly divided into four groups (n=40). A total volume of 1.8 mL containing 9 mg of plain bupivacaine (Group A), 5 mg of plain bupivacaine plus 40 µg fentanyl (Group B), 5 mg of plain levobupivacaine plus 40 µg fentanyl (Group C) and 5mg of hyperbaric bupivacaine plus 40 µg fentanyl (Group D) were applied. Results: Hemodynamic parameters and level of sensory block did not differ among the groups. Time to reach T4 sensory block level was 6 ± 1 min for Group A, 4 ± 1 min for Group B and C, and 7.5±2.5 min for Group D (P= 0.045). Bromage scores were: 110.5 ± 10.1 min, 90.1 ±11.1 min, and 85.1 ± 10.2 min for Group A, B and D, respectively. The patients in Group C had no motor block. Conclusions: Combining fentanyl (40 µg) with low dose (5 mg) isobaric and hyperbaric bupivacaine, and isobaric levobupivacaine provided sufficient anesthesia. Sensory block with no motor block was provided by adding fentanyl, especially to levobupivacaine, which eases perioperative period and delivers patient comfort.

Comparison of two spinal needle types to achieve a unilateral spinal block

Unilateral spinal anesthesia is beneficial in patients undergoing unilateral leg surgery. The direction and the shape of the spinal needle are thought to influence the unilateral distribution of the local anesthetic in the intrathecal space. Therefore, to study the effects of different spinal needles we compared the effects of the Whitacre and Quincke spinal needles. This was a prospective, randomized, double-blind study of 60 consecutive outpatients scheduled for unilateral lower-limb surgery. The patients were randomized to receive spinal anesthesia with 1.2ml of 0.5% plain bupivacaine using either a 27-G Whitacre or a Quincke needle. One half of the local anesthetic was injected towards the nondependent side and the other half was directed cranially. The spread of spinal anesthesia, both sensory and motor blocks, was defined as the primary endpoint and was recorded at 10, 20, and 30min after the spinal injection, at the end of the operation, 2h after the spinal injection, and every 30min thereafter until there was no motor block. Secondary endpoints included patient satisfaction and adverse effects. There was no difference in the spread of sensory or motor blocks between the Whitacre and the Quincke groups. However, the sensory and motor blocks on the operated and the nonoperated sides were significantly different at all testing times, as expected. There was no difference in the incidence of adverse effects or patient satisfaction scores between the Whitacre and the Quincke groups. Unilateral spinal block for outpatient surgery can be achieved with both pencil-point (Whitacre) and Quincke needles using 6.0mg of plain bupivacaine. Neither the spread of sensory and motor blocks nor the corresponding recovery times appeared to be different between the groups. Nor was there any difference in patient satisfaction.

Spinal anaesthesia with articaine 5% vs bupivacaine 0.5% for day-case lower limb surgery: a double-blind randomized clinical trial

A local anaesthetic with fast onset and short reliable duration of anaesthesia may be preferable for out-patient lower limb surgery. Articaine is believed to act faster and to have a shorter duration of action than bupivacaine, but there are no conclusive data available. The purpose of this study was to compare articaine and bupivacaine for day-case lower limb surgery. Eighty patients planned for day-case lower limb surgery enrolled in this study. Patients were randomized to receive hyperbaric articaine 80 mg or plain bupivacaine 15 mg intrathecally. Primary outcome variable was recovery time from motor block. Secondary outcomes were: onset of sensory and motor block, maximum spread of sensory block, time to micturition, discharge from the hospital, and complications. The groups were comparable for the medians and the range of the maximum blocks after 30 min. Median time to complete regression of motor block was 101 min (range 80-129) for articaine compared with 307 min (range 225-350) for bupivacaine (P<0.0005). First spontaneous micturition occurred after 257 min (210-293) in the articaine group and after 350 min (304-370) in the bupivacaine group (P<0.0005). In the articaine and bupivacaine groups, patients were discharged after 300 min (273-347) and 380 min (332-431), respectively (P<0.0005). There was no significant difference in the occurrence of complications between the groups. Spinal anaesthesia with 80 mg of hyperbaric articaine has a shorter duration than a spinal anaesthesia with 15 mg of plain bupivacaine in lower limb surgery of approximately 1 h duration.

A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery

In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia. Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg-1 of S(+) ketamine (1.0 mL) in Group K (n =30) or 25 microg (1.0 mL) of fentanyl in Group F (n =30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia. The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001). In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg-1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.

Improved analgesia with clonidine when added to local anesthetic during combined spinal‐epidural anesthesia for hip arthroplasty: a double‐blind, randomized and placebo‐controlled study

The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty. This was a double-blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 microg of clonidine (Group BC-RC) or without clonidine (Groups B-R and B-RC). Postoperatively, epidural infusion was administered in the following way: Group B-R-ropivacaine 4 mg h(-1); Groups B-RC and BC-RC: ropivacaine 4 mg h(-1) and clonidine 40 microg h(-1). Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli. The maximal upper level of sensory block measured by pin-prick (T6-T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin-prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC-RC compared to Groups B-R and B-RC (P < 0.02). Postoperatively, both VAS score on movement and PCA-morphine consumption were higher in Group B-R than in Groups B-RC and BC-RC (P < 0.01). The arterial pressure and heart rate in Groups B-RC and BC-RC were significantly lower than in Group B-R at 10-24 and 15-24 h, respectively, after spinal injection. Low-dose intrathecal clonidine provided a better quality of anesthesia and longer-lasting analgesia. Epidural clonidine-ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.

The pharmacokinetics and pharmacodynamics of bupivacaine-loaded microspheres on a brachial plexus block model in sheep.

We evaluated bupivacaine-loaded microspheres (B-Ms) using a brachial plexus block model in sheep. In the first step, pharmacokinetic characterization of 75 mg bupivacaine hydrochloride (B-HCl) (IV infusion and brachial plexus block) was performed (n = 12). In the second step, a brachial plexus block dose response study of B-HCl was performed with 37.5 mg, 75 mg, 150 mg, 300 mg, and 750 mg. As a comparison, evaluations were performed using a 750-mg bupivacaine base (B). In the third step, evaluations of brachial plexus block were performed with B-Ms (750 mg of B as B-Ms) using two formulations, 60/40 and 50/50 (w/w %); drug-free microspheres were also evaluated. Toxicity evaluations were also performed after IV administration of B-HCl (750 mg and 300 mg), B-Ms (750 mg), and drug-free microspheres (30 mL over 1 min). As the B-HCl dose increased, the time of onset of block decreased and the duration of complete motor blockade increased at the expense of an increase in bupivacaine plasma concentrations. The time of maximum concentration appeared to be independent of the B-HCl dose. In brachial plexus block, a 37.5-mg dose of B-HCl did not induce motor blockade whereas a dose of 750 mg of B-HCl was clinically toxic. In the case of IV administration, doses of 300 mg of B-HCl were as toxic as 750 mg of B-HCl. Compared with the 75 mg of B-HCl administration for brachial plexus block, administration of 750 mg of B as B-Ms increased the duration of complete motor blockade without significant difference in maximum concentration. No significant clinical difference between the two formulations of B-Ms was demonstrated. The IV administration of B-Ms was safe. We conclude that the controlled release of bupivacaine from microspheres prolonged the brachial plexus block without obvious toxicity. Administration of 750 mg of bupivacaine as loaded-microspheres resulted in prolongation of brachial plexus block in sheep. The peak plasma concentration was not significantly larger than that obtained with 75 mg of plain bupivacaine. The motor blockade was increased more than six times compared with 75 mg plain bupivacaine.

Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: A preliminary report

Background and Objectives: The purpose of our study was to evaluate the quality of anesthesia for cesarean delivery (CD), analgesia for labor (LA), hemodynamic changes, and neonatal effects of combined spinal and epidural anesthesia (CSE) with low intrathecal doses of bupivacaine and fentanyl in patients with severe preeclampsia. Methods: Of the 85 patients with severe preeclampsia (systolic pressures [SBP] ≥160 mm Hg or diastolic pressures [DBP] ≥110 mm Hg, and proteinuria ≥100 mg/dL), 46 underwent CD and 39 delivered vaginally. The CD group received 7.5 mg of hyperbaric bupivacaine and 25 μg fentanyl intrathecally with a goal of obtaining a T4 sensory block. Those with levels less than T4 received 2% lidocaine epidurally to extend the block. In the LA group, the intrathecal dose was 1.25 mg of plain bupivacaine with 25 μg of fentanyl, followed by epidural infusion of 0.0625% to 0.125% bupivacaine with 2 to 4 μg fentanyl/mL at 12 to 15 mL/h. Results: In the CD group, all but 4 patients had ≥T4 block, and these 4 patients received 2% lidocaine epidurally. None required conversion to general anesthesia. In the LA group, sensory levels were T10 (range, T6-L2) with adequate analgesia. The baseline mean arterial pressure (MAP) was 122 ± 13 mm Hg in the CD group and 117 ± 12 mm Hg in the LA group. After CSE, MAP decreased significantly and reached a nadir within 5 minutes in both groups (103 ± 12 mm Hg in the CD group and 96 ± 13 mm Hg in the LA group, P < .05). The maximum decrease in MAP was similar in the 2 groups (−15% ± 8% in the CD group and −16% ± 9% in the LA group). The neonatal Apgar scores and umbilical artery (UA) pH were similar, and there were no significant correlations between UA pH and lowest MAP before delivery or the maximum percentage change in MAP in either group. Conclusions: The results indicate that CSE with low intrathecal doses of bupivacaine and epidural supplementation, when needed, produces adequate anesthesia for CD and analgesia for labor in patients with severe preeclampsia. The maximum decreases in MAP after CSE were modest and quite similar in the 2 groups. Reg Anesth Pain Med 2001;26:46-51.

The Epidural "Top-Up" in Combined Spinal-Epidural Anesthesia

The reinforcement of anesthesia by an epidural "top-up" in combined spinal-epidural anesthesia may be explained by a dual mechanism: a volume effect compressing the dural sac and a local anesthetic effect. The purpose of our study was to investigate the relative importance of each of these factors. Fifty patients scheduled for lower limb orthopedic surgery under combined spinal-epidural anesthesia were randomly allocated to one of five groups comprising 10 patients each. Using a needle-through-needle technique, all patients received a subarachnoid injection of 10 mg of plain bupivacaine and an epidural catheter. After the maximal level of sensory blockade as a result of the subarachnoid injection had been established, an epidural top-up was given according to the randomization code. Patients in Group 1 received 10 mL of bupivacaine 0.25%; patients in Group 2 received 10 mL of saline; patients in Group 3 received 5 mL of bupivacaine 0.5%; patients in Group 4 received 5 mL of saline; and patients in Group 5 received no epidural top-up. The maximal level of sensory blockade was then assessed for an additional 30 min. In Groups 1-4, the maximal level of sensory blockade increased significantly, whereas there was no significant increase in Group 5. There was no significant difference in the increase in the maximal level of sensory blockade among Groups 1-4. We conclude that, under the conditions of our study, there is no difference between 5 and 10 mL with regard to the volume effect of an epidural top-up in combined spinal-epidural anesthesia and that to produce an additional local anesthetic effect with bupivacaine, the dose must be larger than 25 mg. Implications: In combined spinal-epidural anesthesia, an epidural "top-up" may increase the maximal level of sensory blockade by means of a volume effect and a local anesthetic effect. In this study, volumes of 5 and 10 mL produced a similar increase, and 25 mg of bupivacaine was insufficient to produce an additional local anesthetic effect. (Anesth Analg 1999;88:810-4)

Postoperative analgesia in herniorrhaphy with local anesthesia and monitored anesthesia care

In this study the authors evaluated the grade of acceptance and the operating conditions of unilateral primary herniorrhaphy under local anesthesia and monitored anesthesia care (MAC). The amount of pain in the immediate postoperative period was assessed and the efficacy of treatment using a popular non-opiate analgesic, magnesic metamizol, by the oral route was studied. In a period of six months 63 consecutive patients were operated on by the same surgeon using the same technique of hernia repair (Shouldice technique) with local infiltration anesthesia supplemented by MAC in the form of conscious sedation. A mixture of 300 mg of plain mepivacaine and 50 mg of plain bupivacaine was used for infiltration. A standard dose of fentanyl 0.10 mg and midazolam 2 mg was used for conscious sedation. Propofol in continuous infusion was also employed. The average dose of propofol varied from 1–3 mg/kg/h. Conscious level was assessed using a five-point sedation score. A level-3 end point was persued (closed eyes, but answer verbal orders). Pain intensity in the postoperative period was measured by the visual analogue scale (VAS) and the verbal pain scale (VPS), based on the McGill pain questionnaire. The operating conditions were excellent in all cases except in three patients. In no case conversion to general anesthesia was necessary. In the postoperative period, 5 patients (8%) never felt pain and 58 (92%) felt pain on the average 4 hours 36 minutes after the local infiltration (VAS=2.5; VPS=1.45). Of the 58 patients 49 took the first dose of oral analgesic 6 hours 40 minutes after infiltration (VAS=4; VPS=1.97). All patients were satisfied with the anesthetic-surgical technique and were ready to repeat the experience. However, when the patients took the second dose of oral analgesic 28% of them had moderate pain and 9% severe pain. Our conclusions are that local infiltration with MAC is a valid and satisfying experience for both the patient and the surgeon. Nevertheless, further attempts should be made to better the postoperative pain relief when the oral route is elected.

Extradural bupivacaine‐loaded microspheres and spinal cord bloodflow in the chronically instrumented rabbit

The local anaesthetic agent bupivacaine decreases spinal cord blood flow. This study documents the effect of bupivacaine-loaded polylactic acid microspheres, a formulation allowing sustained release, in the awake rabbit. Animals received at random extradural injection (1 ml) of either 5 mg of plain bupivacaine (n = 6) or 5 mg of bupivacaine-loaded microspheres (n = 6). Arterial blood pressure, cardiac output and spinal cord blood flow, using radioactive microspheres, and arterial blood gas tensions were measured before (T0) and 30 (T30) and 120 (T120) min after the extradural injection. Motor blockade was assessed on a four-point scale every 5 min until complete recovery. All rabbits experienced paralysis of hindlimbs. Those receiving bupivacaine recovered completely before T120, and the block duration was 86 +/- 23 min (mean +/- SD), whereas the block duration was 210 +/- 60 min (P < 0.05) in those receiving the microsphere formulation. Left renal blood flow baseline was 470 +/- 179 (mean +/- SD) and right renal blood flow was 464 +/- 177 ml min(-1) 100g(-1) and did not vary significantly throughout the experiment. Lumbar spinal cord blood flow decreased in both groups, at T30 with bupivacaine (-16 +/- 7%) and at T120 with microspheres (-12 +/- 8%). Arterial blood pressure decreased more rapidly with bupivacaine (-20 +/- 14% within 15 min) than with microspheres (-19 +/- 11% within 30 min) and returned to baseline at T120 in both groups. Cardiac output and arterial blood gas tensions did not change significantly. We conclude that polylactic acid microspheres can prolong motor blockade from bupivacaine. Whatever its formulation, and independently of systemic haemodynamic and blood gas variables, bupivacaine leads to a decrease in spinal cord blood flow, which persists for the duration of motor blockade. This suggests that motor block must be avoided in clinical practice when extradural bupivacaine is used for pain relief.

Continuous Spinal Analgesia: Comparison Between Patient-Controlled and Bolus Administration of Plain Bupivacaine for Postoperative Pain Relief

Background and ObjectivesAdequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement.MethodsForty-two patients (mean age, 69 ± 11 years) were randomly allocated to one of two groups. Group 1 patients received a constant subarachnoid infusion of 0.6 mg/h of bupivacaine by a patientcontrolled device and were allowed to self-administer 0.6 mg every 30 minutes Group 2 patients received a nurse-administered bolus of 3.75 mg of plain bupivacaine on request. Pain was assessed by patients and nurses by a visual analog scale (VAS) every hour. The degree of motor block and the level of analgesia were documented every 4 hours. Hemodynamic and respiratory parameters were recorded hourly. Differences between groups were tested by analysis of variance for repeated measurement.ResultsTechnical problems occurred in six patients were more frequent in group 1 but none in group 2. Patient-controlled analgesia resulted in lower pain scores than bolus application during 18 postoperative hours (VAS score 19 ± 19 mm in group 1 and 39 ± 30 mm in group 2; P &lt; .01). Lower total doses of bupivacaine were required in group 1 (17.6 ± 4 mg) than in group 2 (22.3 ± 7 mg: P &lt; .05). The groups did not differ with respect to the degree of motor block (Bromage score 3.5 ± 0.5), the sensory level (L1-2 ± 1), or hemodynamic or respiratory parameters.ConclusionIn spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.

Continuous spinal analgesia: Comparison between patient-controlled and bolus administration of plain bupivacaine for postoperative pain relief

Adequate postoperative pain relief has been achieved in orthopedic patients by subarachnoid bolus administration of plain bupivacaine. This prospective randomized study compares bolus injections of bupivacaine with a patient controlled infusion via subarachnoid 28-gauge microcatheters for postoperative analgesia after elective hip replacement. Forty-two patients (mean age, 69 +/- 11 years) were randomly allocated to one of two groups. Group. 1 patients received a constant subarachnoid infusion of 0.6 mg/h of bupivacaine by a patient-controlled device and were allowed to self-administer 0.6 mg every 30 minutes Group 2 patients received a nurse-administered bolus of 3.75 mg of plain bupivacaine on request. Pain was assessed by patients and nurses by a visual analog scale (VAS) every hour. The degree of motor block and the level of analgesia were documented every 4 hours. Hemodynamic and respiratory parameters were recorded hourly. Differences between groups were tested by analysis of variance for repeated measurement. Technical problems occurred in six patients were more frequent in group 1 but none in group 2. Patient-controlled analgesia resulted in lower pain scores than bolus application during 18 postoperative hours (VAS score 19 +/- 19 mm in group 1 and 39 +/- 30 mm in group 2; P < .01). Lower total doses of bupivacaine were required in group 1 (17.6 +/- 4 mg) than in group 2 (22.3 +/- 7 mg; P < .05). The groups did not differ with respect to the degree of motor block (Bromage score 3.5 +/- 0.5), the sensory level (L1-2 +/- 1), or hemodynamic or respiratory parameters. In spite of a higher incidence of technical problems, patient-controlled analgesia with a continuous background infusion via microspinal catheters provides more effective postoperative analgesia, without hemodynamic or respiratory side effects, than bolus administration.

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

25%, severe global hypokinesis, and moderate mitral regurgitation. The patient also had a history of hypertension, atria1 fibrillation (AF), and noninsulin-dependent diabetes. His preoperative medications included digoxin, furosemide, enalapril, nitroglycerin patch, and glyburide. He had no known drug allergies. On physical examination, the patient was 180 cm in height and weighed 62 kg. Heart rate (HR) and blood pressure (BP) were 74 bpm and 120/70 mm Hg, respectively. Head and neck evaluation was significant for a Mallampati class II airway and decreased range of motion of the neck. The cardiac examination revealed an irregularly irregular heart beat with a grade 3/6 systolic murmur. The lungs were clear to auscultation. The electrocardiogram (ECG) revealed AF with a ventric

The association between foot temperature and asymmetrical epidural blockade

This study was designed to explore the correlation between sensory block asymmetry and a disparity in foot temperature following epidural bupivacaine administration in labour. Sixty parturients requesting epidural analgesia had epidural catheters sited at L 3 4 while in the lateral position. A test dose was followed 5 min later by a main dose of 25–30 mg of plain bupivacaine. A thermistor thermometer recorded the temperature of the feet before and 5, 10, 15, 20 and 30 min after the end of the main dose. The upper and lower limits of sensory blockade on both the left and right sides were recorded at the same time intervals. Spearman's coefficient of rank correlation between sensory block asymmetry and foot temperature difference were at 5 min: 0.4, 10 min: 0.39, 15 min: 0.54, 20 min: 0.59 and 30 min: 0.6. This was significant at 5 and 10 min ( P < 0.05) and highly significant at 15, 20 and 30 min ( P < 0.001). During the 30 min period after the end of the main dose, 45 midwives, junior and senior medical staff (up to 4 observers per patient) were asked if they could detect foot temperature asymmetry. Their observations were compared with the thermistor readings. Most staff were able to detect a foot temperature difference > 1°C. Our findings indicate a clear association between sensory block asymmetry and the difference between the temperature of the feet. This difference can be detected simply by feeling the feet.

Incremental Dosing Versus Single-Dose Spinal Anesthesia and Hemodynamic Stability

We compared the hemodynamic stability after spinal anesthesia with two different dosing regimens in the elderly. Fifty patients, all older than 60 yr and scheduled for elective knee or hip surgery were assigned to two groups. After administration of 10 mL/kg of lactated Ringer's solution (RL) intravenously (i.v.) in the first group, we performed a continuous spinal anesthesia (CSA) by means of a 28-gauge catheter through which repetitive injections of 2.5-5 mg of plain bupivacaine 0.5% were given. In the other group, a single-dose spinal anesthesia (SS) with 20 mg of the same local anesthetic (LA) was carried out. Noninvasive mean arterial pressure (MAP), heart rate, and levels of analgesia were measured. To maintain MAP within 25% of initial value, the patients received additional i.v. fluids (RL) as first measure. When MAP could not be maintained despite hydration, incremental doses of ephedrine were given i.v. Six patients in the CSA group and 17 in the SS group developed a level of anesthesia higher than T6 (P < 0.01). In the SS group more fluid was needed (792 vs 388 ml) than in the CSA group (P < 0.01). Moreover, more patients of the SS group (11 vs 4) required ephedrine (P < 0.05). We conclude that CSA produces reliable and predictable analgesia for lower limb surgery with less need for correction of hemodynamic changes compared to SS.