Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study

Gudaityte, Jurate; Marchertiene, Irena; Karbonskiene, Aurika; Saladzinskas, Zilvinas; Tamelis, Algimantas; Toker, Igoris; Pavalkis, Dainius

doi:10.1016/j.jclinane.2008.11.014

« Previous Next »Journal of Clinical Anesthesia
Volume 21, Issue 7 , Pages 474-481, November 2009

Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study☆

Jurate Gudaityte, Dr. Med. Sc. (Lecturer)
- Department of Anesthesiology, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
- Corresponding author. Tel.: +370 37 326221; fax: +370 37 326427.
Irena Marchertiene, Dr. Med. Sc. (Assoc. Professor)
- Department of Anesthesiology, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
Aurika Karbonskiene, Dr. Med. Sc. (Assoc. Professor)
- Department of Anesthesiology, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
Zilvinas Saladzinskas, Dr. Med. Sc. (Assoc. Professor)
- Unit of Coloproctology, Department of Surgery, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
Algimantas Tamelis, Dr. Med. Sc. (Assoc. Professor)
- Unit of Coloproctology, Department of Surgery, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
Igoris Toker, Dr.
- Unit of Coloproctology, Department of Surgery, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania
Dainius Pavalkis, Dr. Med. Sc. (Professor)
- Unit of Coloproctology, Department of Surgery, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania

Received 28 February 2007; received in revised form 24 November 2008; accepted 26 November 2008. published online 26 October 2009.

Abstract

Background and objective

To produce selective spinal anesthesia for adult anorectal surgery.

Study design

Double-blinded, randomized, controlled trial.

Setting

Operating room and postoperative recovery area.

Patients

152 adult, consecutive ASA physical status I, II, and III patients.

Interventions

After patients underwent dural puncture in the sitting position at L3-L4 or L4-L5, 0.5% hyperbaric bupivacaine was injected over two minutes: Group S7.5 received 1.5 mL, Group S5 received 1.0 mL, and Group S4 0.8 mL. After sitting for 10 minutes, patients were positioned for surgery.

Measurements

Rate of success, level and duration of sensory and motor block, time to voiding and ambulation, complications, and quality of anesthesia according to the patient and medical staff, were recorded.

Results

Spinal block had a 98% rate of success. Mean level of sensory block was 10.4 ± 1.7, 7.4 ± 2.2, and 7.0 ± 1.8 dermatomes in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, and S7.5 vs S4). Mean duration of sensory block was 310.5 ± 42.6, 255.9 ± 43.7, and 228.8 ± 34.8 min in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, S7.5 vs S4, and S5 vs S4). Motor block was Bromage score 2-3 in 70.5% of Group S7.5 patients versus Bromage score 0-1 in 97.3% of Group S5 and 92.1% of Group S4 patients (P < 0.05).

Conclusion

A dose of 4 mg of hyperbaric bupivacaine produces a similar level of sensory and motor block as a 5 mg dose but with shorter duration and faster recovery.

Keywords: Anesthesia conduction, Spinal, Anesthetics local, Bupivacaine, Hyperbaric, Dose-response relationship, Drug, Colorectal Surgery, Anorectal