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Frequency of hypotension during conventional or asymmetric hyperbaric spinal block.

Abstract：

BACKGROUND AND OBJECTIVES:The purpose of this randomized, double-blind study was to evaluate if use of an asymmetric spinal block affects the incidence of hypotension during spinal anesthesia. METHODS:With Ethical Committee approval and patient consent, 120 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent, and received 8 mg 0.5% hyperbaric bupivacaine through a 25-gauge Whitacre spinal needle. Patients were randomized to one of two groups: (a) local anesthetic was injected with barbotage through a cranially directed needle orifice, then patients were immediately turned to supine (conventional, n = 60); (b) local anesthetic was injected without barbotage with the needle orifice turned toward the dependent side, then the lateral position was maintained for 15 minutes (unilateral, n = 60). A blind observer recorded noninvasive hemodynamic variables, as well as loss of cold and pinprick sensation and motor block on both sides. RESULTS:In the unilateral group, 31 patients (52%) showed a unilateral loss of cold sensation and 48 patients (80%) had no motor block on the nondependent side for the duration of the study, whereas all conventional patients had bilateral distribution of spinal block (P < .0001). The onset time and two-segment regression of sensory block on the dependent side were more rapid in the conventional group (18 +/- 7 minutes and 60 +/- 18 minutes) than in the unilateral group (22 +/- 8 minutes and 67 +/- 19 minutes) (P < .05 and P < .05, respectively). The incidence of hypotension (SAP decrease >30% from baseline) was higher in the conventional (22.4%) than unilateral group (5%) (P < .01). The maximum percentage changes from baseline values of systolic arterial blood pressure and heart rate were greater in conventional group (-28% +/- 16% and -19% +/- 10%) than in unilateral group (-8% +/- 16% and -12% +/- 18%) (P < .0001 and P < .01, respectively). CONCLUSIONS:Achieving an asymmetric distribution of spinal block by injecting a small dose of 0.5% hyperbaric bupivacaine through a Whitacre spinal needle into patients placed in the lateral position for 15 min reduces the incidence of hypotension during spinal anesthesia.

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Casati A,Fanelli G,Aldegheri G,Colnaghi E,Casaletti E,Cedrati V,Torri G

doi

10.1016/s1098-7339(99)90130-x

subject

Has Abstract

pub_date

1999-05-01 00:00:00

pages

214-9

issue

eissn

1098-7339

issn

1532-8651

pii

S1098-7339(99)90130-X

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

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Frequency of hypotension during conventional or asymmetric hyperbaric spinal block.