Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.08.009
Brazilian Journal of Anesthesiology
Scientific Article

A comparison of different densities of levobupivacaine solutions for unilateral spinal anaesthesia

Uma comparação das diferentes densidades das soluções de levobupivacaína para raquianestesia unilateral

Özgür Yagan; Nilay Tas; Ahmet Küçük; Volkan Hanci

http://dx.doi.org/10.1016/j.bjane.2014.08.009 Braz J Anesthesiol, vol.66, n2, p.157-164, 2016
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Abstract

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of the study was to compare the block characteristics and clinical effects of dextrose added to levobupivacaine solutions at different concentrations to provide unilateral spinal anaesthesia in lower extremity surgery. METHODS: This prospective, randomised, double-blind study comprised 75 ASA I-II risk patients for whom unilateral total knee arthroscopy was planned. The patients were assigned to three groups: in Group I, 60 mg dextrose was added to 7.5 mg of 0.5% levobupivacaine, in Group II, 80 mg and in Group III, 100 mg. Spinal anaesthesia was applied to the patient in the lateral decubitus position with the operated side below and the patient was kept in position for 10 min. RESULTS: The time for the sensorial block to achieve T12 level was slower in Group I than in Groups II and III (p < 0.05, p< 0.00). The time to full recovery of the sensorial block was 136 min in Group I, 154 min in Group II and 170 min in Group III. The differences were statistically significant (p < 0.05). The mean duration of the motor block was 88 min in Group I, 105 min in Group II, and 139 min in Group III and the differences were statistically significant (p < 0.05). The time to urination in Group I was statistically significantly shorter than in the other groups (p < 0.00). CONCLUSIONS: The results of the study showed that together with an increase in density, the sensory and motor block duration was lengthened. It can be concluded that 30 mg mL-1 concentration of dextrose added to 7.5 mg levobupivacaine is sufficient to provide unilateral spinal anaesthesia in day-case arthroscopic knee surgery.

Keywords

Hyperbaric levobupivacaine, Unilateral spinal anaesthesia, Arthroscopic knee surgery

Resumo

RESUMO JUSTIFICATIVA E OBJETIVOS: Comparar as características do bloqueio e os efeitos clínicos da adição de dextrose às soluções de levobupivacaína em diferentes concentrações para proporcionar raquianestesia unilateral em cirurgia de extremidade inferior. MÉTODOS: Estudo prospectivo, randômico e duplo-cego conduzido com 75 pacientes, estado físico ASA I-II, programados para artroplastia unilateral total do joelho. Os pacientes foram divididos em três grupos: no Grupo-I, 60 mg de dextrose foram adicionados a 7,5 mg de levobupivacaína a 0,5%; no Grupo II, 80 mg e no Grupo III, 100 mg. A raquianestesia foi aplicada ao paciente posicionado em decúbito lateral, com o lado operado abaixo, e o paciente foi mantido em posição durante 10 minutos. RESULTADOS: O tempo para o bloqueio sensorial atingir o nível T12 foi mais lento no Grupo-I do que nos grupos II e III (p < 0,05,p < 0,00). O tempo de recuperação total do bloqueio sensorial foi de 136 minutos no Grupo-I, 154 minutos no Grupo-II e 170 minutos no Grupo III. As diferenças foram estatisticamente significativas (p < 0,05). A média da duração do bloqueio motor foi de 88 minutos no Grupo-I, 105 minutos no Grupo-II e 139 minutos no Grupo-III e as diferenças foram estatisticamente significativas (p< 0,05). O tempo de micção foi significativamente menor no Grupo-I do que nos outros grupos (p < 0,00). CONCLUSÕES: Os resultados do estudo mostraram que, junto com um aumento da densidade, a duração dos bloqueios sensorial e motor foi prolongada. Pode-se concluir que uma concentração 30 mg mL-1 de dextrose adicionada a 7,5 mg de levobupivacaína é suficiente para proporcionar raquianestesia unilateral para artroscopia do joelho em regime ambulatorial.

Palavras-chave

Levobupivacaína hiperbárica, Raquianestesia unilateral, Artroscopia do joelho

References

Stienstra R, Gielen M, Kroon JW. The influence of temperature and speed of injection on the distribution of a solution containing bupivacaine and methylene blue in a spinal canal model. Reg Anesth. 1990;15:6-11.

Breitkreutz R, Kessler P. Hyperbaric levobupivacaine formulation for fast track urological or outpatient surgery a new magic bullet?. Minerva Anestesiol. 2010;76:5-6.

Kazak Z, Ekmekci P, Kazbek K. Hyperbaric levobupivacaine in anal surgery spinal perianal and spinal saddle blocks. Anaesthesist. 2010;59:709-13.

Djeno IT, Duzel V, Ajduk M. Increase in specific density of levobupivacaine and fentanyl solution ensures lower incidence of inadequate block. Coll Antropol. 2012;36:375-80.

Hakan Erbay R, Ermumcu O, Hanci V. A comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery a randomized controlled trial. Minerva Anestesiol. 2010;76:992-1001.

Sen H, Purtuloglu T, Sizlan A. Comparison of intrathecal hyperbaric and isobaric levobupivacaine in urological surgery. Minerva Anestesiol. 2010;76:24-8.

Moher D, Schulz KF, Altman DG. The CONSORT statement revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.

Cappelleri G, Aldegheri G, Danelli G. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy a prospective, randomized, double-blind study. Anesth Analg. 2005;101:77-82.

Imbelloni LE, Gouveia MA, Carneiro AF. Reducing the concentration to 0 4% enantiomeric excess hyperbaric levobupivacaine (s75: r25) provides unilateral spinal anesthesia. Study with different volumes. Rev Bras Anestesiol. 2012;62:654-64.

Casati A, Moizo E, Marchetti C. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg. 2004;99:1387-92.

Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;101:705-10.

Browner WS, Black D, Newman B. Estimating sample size and power. Designing clinical research:an epidemiologic approach. 1988:139-50.

Glaser C, Marhofer P, Zimpfer G. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002;94:194-8.

Cuvas O, Er AE, Ongen E. Spinal anesthesia for transurethral resection operations bupivacaine versus levobupivacaine. Minerva Anestesiol. 2008;74:697-701.

Erdil F, Bulut S, Demirbilek S. The effects of intrathecal levobupivacaine and bupivacaine in the elderly. Anaesthesia. 2009;64:942-6.

Morrison SG, Dominguez JJ, Frascarola P. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg. 2000;90:1308-14.

Cox CR, Faccenda KA, Gilhooly C. Extradural S(-)bupivacaine comparison with racemic RS-bupivacaine. Br J Anaesth. 1998;80:289-93.

Bardsley H, Gristwood R, Baker H. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol. 1998;46:245-9.

Atef H, Ael-D El-Kasaby, Omera M. Optimal dose of hyperbaric bupivacaine 0 5% for unilateral spinal anesthesia during diagnostic knee arthroscopy. Middle East J Anesthesiol. 2012;21:591-8.

Pitkänen M, Rosenberg PH. Local anaesthetics and additives for spinal anaesthesia characteristics and factors influencing the spread and duration of the block. Best Pract Res Clin Anaesthesiol. 2003;17:305-22.

Stienstra R, Veering BT. Intrathecal drug spread: is it controllable?. Reg Anesth Pain Med. 1998;23:347-51.

McLeod GA. Density of spinal anaesthetic solutions of bupivacaine, levobupivacaine, and ropivacaine with and without dextrose. Br J Anaesth. 2004;92:547-51.

Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004;93:568-78.

Sönmez B, Akçay M, Akçaboy EY. Effects of unilateral spinal anesthesia with low dose bupivacaine and bupivacaine-fentanyl combination on recovery. J Clin Exp Invest. 2011;2:22-9.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med. 2000;25:605-10.

Whiteside JB, Burke D, Wildsmith JA. Spinal anaesthesia with ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1). Br J Anaesth. 2001;86:241-4.

Fettes PD, Hocking G, Peterson MK. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth. 2005;94:107-11.

Janik R, Dick W, Stanton-Hicks MD. Effects of different glucose concentrations on spinal anaesthesia with bupivacaine and tetracaine. Eur J Anaesthesiol. 1989;6:215-21.

Bannister J, McClure JH, Wildsmith JA. Effect of glucose concentration on the intrathecal spread of 0 5% bupivacaine. Br J Anaesth. 1990;64:232-4.

Sanansilp V, Trivate T, Chompubai P. Clinical characteristics of spinal levobupivacaine hyperbaric compared with isobaric solution. Sci World J. 2012;2012:169076.

Tsai YJ, Tso HS, Chang CL. Spinal anesthesia with bupivacaine for transurethral resection of prostate effects of specific gravity, volume and dose. Ma Zui Xue Za Zhi. 1989;27:111-6.

Critchley LA, Morley AP, Derrick J. The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%. Anaesthesia. 1999;54:469-74.

Casati A, Fanelli G, Aldegheri G. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med. 1999;24:214-9.

Pittoni G, Toffoletto F, Calcarella G. Spinal anesthesia in outpatient knee surgery 22-gauge versus 25-gauge Sprotte needle. Anesth Analg. 1995;81:73-9.

Beardsley D, Holman S, Gantt R. Transient neurologic deficit after spinal anesthesia local anesthetic maldistribution with pencil point needles?. Anesth Analg. 1995;81:314-20.

Mulroy MF, Salinas FV, Larkin KL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology. 2002;97:315-9.

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