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