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Spinal anaesthesia with hypobaric 0.19% or plain 0.5% bupivacaine
T Taivainen1, M Tuominen, P H Rosenberg
1Department of Anaesthesia, Helsinki University Central Hospital, Finland.
British Journal of Anaesthesia
|August 1, 1990
Summary
Hypobaric spinal anesthesia using bupivacaine caused extensive sensory block spread to the cervical nerves, leading to significant hypotension. This technique is not recommended for routine use in lower extremity orthopedic surgery.
Area of Science:
- Anesthesiology
- Neurosurgery
Background:
- Spinal anesthesia is a common technique for lower extremity surgery.
- Bupivacaine is a frequently used local anesthetic for spinal anesthesia.
Purpose of the Study:
- To compare the efficacy and spread of hypobaric 0.19% bupivacaine with plain 0.5% bupivacaine for spinal anesthesia.
- To evaluate the safety and suitability of hypobaric bupivacaine for routine use.
Main Methods:
- A comparative study involving 29 healthy patients undergoing lower extremity orthopedic surgery.
- Injection of hypobaric 0.19% bupivacaine or plain 0.5% bupivacaine at the L3-4 interspace.
- Patients maintained a sitting position for 2 minutes post-injection.
Main Results:
- Hypobaric bupivacaine resulted in a significantly higher cephalad spread of sensory block, reaching the T1 segment compared to T8 for plain bupivacaine (P < 0.0001).
- The study was halted due to extreme sensory block spread to C2 in one patient within 5 minutes.
- Hypobaric bupivacaine frequently affected upper thoracic and cervical nerves, accompanied by marked hypotension.
Conclusions:
- The extensive and unpredictable spread of hypobaric bupivacaine spinal anesthesia poses significant risks.
- This technique is unsuitable for routine clinical application due to the high incidence of adverse events like hypotension.
- Further research may be needed to explore modifications or alternative formulations for safer hypobaric spinal anesthesia.