Low-dose (5 mg) hyperbaric bupivacaine for unilateral spinal anesthesia in arthroscopic knee surgeries
Background. In the last two decades, there has been a clear trend towards an increase in the number of outpatient operations in order to reduce the cost of treatment and reduce the length of the patient’s stay in the hospital. Arthroscopic knee surgery is one of these cases. Among the broad spectrum of techniques, spinal anesthesia (general anesthesia with propofol, fentanil, sevoflurane and laryngeal mask; nerve blocks) holds important but not the leading place. The ability of spinal anesthesia to provide sensory and motor blockade in conjunction with low cost and simplicity makes it indispensible. Arthroscopic knee surgery requires sensory block T12 for tourniquet use, second grade motor block for knee immobility and preservation of patient’s ability to communicate during the operation. Average dose of local anesthetics may lead to protracted blockade and development of adverse reactions which postpone hospital discharge. In order to increase safety, the unilateral spinal anesthesia is recommended. Unilateral spinal anesthesia with low-dose of local anesthetics is a cost-effective and rapidly performed anesthetic technique. In case of unilateral block, one should pay special attention for very slow rate of injection and keeping patient lying in lateral position for proper fixation of local anesthetic. Dose from 3 to 5 mg of hyperbaric bupivacaine is usually recommended. Prevention of hypotension, control of the level and duration of block may be achieved by using low-dose of local anesthetic. Search for effective and safe low-dose of hyperbaric bupivacaine for unilateral spinal anesthesia in arthroscopic knee surgery with fast and safe hospital discharge is continuing. Materials and methods. Thirty patients scheduled for arthroscopic knee surgery were divided into 2 groups. Before the procedure, patients were given normal saline 10 ml/kg for 15 min. During the operation, the saline solution was administered at 7 ml/kg/h. Subarachnoid space was accessed via a 25G Quincke spinal needle through L3–4 in the midline. In group 1 (n = 15), an average dose of hyperbaric bupivacaine (7.5 mg) for spinal anesthesia was injected over 3 min. Group 2 (n = 15) — low-dose of hyperbaric bupivacaine (5 mg) for spinal anesthesia was injected over 3 min. Patients were kept lying in lateral position for 20-minute fixation time. Upon achieving level T12 sensory blockade, patients were placed on their back and the operation started. Level of sensory and motor block on the operated and non-operated side, time to S2 regression, first time an analgetic was needed, walking time, voiding time, release time, quality of anesthesia, blood pressure, heart rate, postdural puncture headache, transient neurologic symptoms were evaluated. Data obtained during the study were evaluated using Microsoft Excel 2007 and Statistica 8.0. Results. The increase in obtaining sensory block level T12, without development of sensory block on the operation side at the level T10–T8, or bilateral sensory and motor block in group 2 was observed. There was no statistically significant difference in blood pressure and heart rate between the groups. Neither hypotension nor bradycardia was observed in both groups. Anesthesia was effective and didn’t require additional interventions in both groups. Quality of anesthesia was accessed as “very good” in all cases in both groups. There was no statistically significant difference in time to S2 regression between the groups. Faster restoration of ability to walk (180.3 ± 24.7 min vs 145.6 ± 21.7 min, p < 0.05, in groups 1 and 2, respectively) and voiding time (275.4 ± 32.5 min vs 151.9 ± 23.2 min, p < 0.05, in groups 1 and 2, respectively) with faster and safe hospital discharge criteria (317.5 ± 33.9 min vs 166.7 ± 28.1 min, p < 0.05, in groups 1 and 2, respectively) were observed in group 2. No cases of postdural puncture headache and transient neurologic symptoms were observed in both groups. Conclusions. Low-dose of hyperbaric bupivacaine (5 mg) for unilateral spinal anesthesia is effective and safe in arthroscopic knee surgery and can provide fast and safe hospital discharge.
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