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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1998 July-August;64(7-8):307-12


language: English

Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block

Casati A., Fanelli G., Beccaria P., Aldegheri G., Berti M., Senatore R., Torri G.

University of Milan, IRCCS H S. Raffaele, Department of Anaesthesiology and Intensive Care


Background. A low ­dose of hyper­bar­ic ­local anaesthet­ic solu­tion, pen­cil ­point nee­dle and ­slow ­speed of intra­the­cal injec­tion ­have ­been report­ed to ­obtain a uni­lat­er­al dis­tri­bu­tion of spi­nal anaesthe­sia. This ­should ­also min­i­mize car­di­o­vas­cu­lar ­effects of spi­nal ­block. The aim of ­this pros­pec­tive, ran­dom­ized, par­allel ­group ­study was to eval­u­ate car­diac per­for­mance dur­ing uni­lat­er­al sub­arach­noid ­block and to com­pare it ­with ­that pro­duced by stan­dard bilat­er­al spi­nal anaesthe­sia.
Methods. With Ethic Committee approv­al and ­patients’ con­sent we stud­ied 30 ASA I-II ­patients sched­uled for one leg sur­gery. Dural punc­ture was per­formed by 25-G Whitacre nee­dle ­with ­patients ­lying in the lat­er­al posi­tion and the ­side to be oper­at­ed on depen­dent. Patients then ran­dom­ly ­received 8 mg of 0.5% hyper­bar­ic bupiv­a­caine inject­ed ­over 80 sec ­with nee­dle hole orien­tat­ed ­towards the depen­dent ­side (Unilateral, n=15), or 15 mg of the ­same solu­tion inject­ed ­over 6 sec ­with nee­dle bev­el cra­ni­al­ly direct­ed (Control, n=15). Only ­patients of the Unilateral ­group ­remained in the lat­er­al posi­tion for 15 min. Noninvasive Arterial ­blood pres­sure, ­heart ­rate, ­stroke vol­ume ­index and car­diac ­index ­were meas­ured ­before spi­nal ­block (base­line) and ­then at 5, 15, 30 and 45 min; ­while sen­so­ry and ­motor ­blocks ­were eval­u­at­ed at 15, 30 and 45 min on ­both ­sides.
Results. Unilateral spi­nal anaesthe­sia was ­observed in 11 ­patients of the Unilateral ­group (73%). Three ­patients of the Control ­group (20%) ­required col­loids for intra­op­er­a­tive hypo­ten­sion. Mean arte­ri­al ­blood pres­sure and ­heart ­rate ­decreased ­from base­line ­only in the Control ­group (p=0.001 and p=0.0003 respec­tive­ly), ­while ­heart ­rate was ­decreased in Control ­even ­when com­pared to Unilateral ­group (p=0.01). The stroke vol­ume ­index was ­unchanged in the two ­groups (p=0.22), ­while the car­diac ­index ­showed a 15-20% ­decrease ­from base­line in Control ­group (p=0.001), ­with a sig­nif­i­cant ­decrease at 30 and 45 min ­when com­pared to Unilateral (p=0.01).
Discussion. The use of 8 mg of 0.5% hyper­bar­ic bupiv­a­caine slow­ly inject­ed ­through a direc­tion­al nee­dle pro­vid­ed a spi­nal ­block rel­a­tive­ly restrict­ed to the oper­a­tive ­side ­with min­i­mal ­effects on car­di­o­vas­cu­lar homeo­sta­sis.

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