DOI: https://doi.org/10.22141/2224-0586.1.96.2019.158755

Low-dose (5 mg) hyperbaric bupivacaine for unilateral spinal anesthesia in arthroscopic knee surgeries

A.G. Tutunnyk, G.V. Panchenko, A.V. Tsarev

Abstract


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.


Keywords


anesthesia; knee joint; arthroscopy

References


Tutunnyk A.G. Single blockade of the femoral nerve with 0.25% bupivacaine in arthroscopic plasty of the anterior cruciate sinus of the knee joint. Medicina neotloznyh sostoanij. 2015; 2: 141-143.

Buttner B., Mansur A., Bauer M. et al. Unilateral spinal anesthesia: Literature review and recommendations. Anaesthesist. 2016; 65(11):847-865.

Macar J.S., Bawdane K.D., Patil R. Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery. J Clin Diagn Res. 2017; 11(7): 17-20. doi: 10.7860/JCDR/2017/26235.10215.

Diaz-Osuna V., Vilchez-Cavazos F., Palacios-Rios D. et al. Local anesthesia and sedation vs. spinal anesthesia for knee arthroscopy. Medicina Universitaria. 2016; 18(72): 153-7.

Mulroy M.F., Larkin K.L., Hodqson P.S. et al. A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy. Anest Analg. 2000; 91(4): 860-4.

Taha A.M., Abd-Elmaksoud A.M. Arthroscopic medial meniscus trimming or repair under nerve blocks: Which nerves should be blocked? Saudi J Anaesth. 2016; 10(3): 283–287.

Moosavi Tekye S.M., Alipour M. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Bras J Anesthesiol. 2014; 64(3): 173-6. doi: 10.1016/j.bjane.2013.06.014.

Wang W., Li Y., Sun A. et al. Determination of the median effective dose (ED50) of bupivacaine and ropivacaine unilateral spinal anesthesia: Prospective, double blinded, randomized dose-response trial. Anaesthesist. 2017; 66(12): 936-943. doi: 10.1007/s00101-017-0370-9.

Sertoz N, Aysel I, Uyar M. The effects of sufentanil added to low-dose hyperbaric bupivacaine in unilateral spinal anaesthesia for outpatients undergoing knee arthroscopy. Agri. 2014; 26(4): 158-64. doi: 10.5505/agri.2014.51422.

Teunkens A, Vermeulen K, Van Gerven E et al. Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting: A Double-Blind Randomized Controlled Trial. Reg Anesth Pain Med. 2016; 41(5): 576-83. doi: 10.1097/AAP.0000000000000420.

Lemoine A, Mazoit JX, Bonnet F. Modelling of the optimal bupivacaine dose for spinal anaesthesia in ambulatory surgery based on data from systematic review. Eur J Anaesthesiol. 2016; 33(11): 846-852.

Memary E, Mirkheshti A, Jabbari Moghaddam M. et al. Comparison of the effects of pre-anesthetic administration of normal saline, ringer and voluven on the spread of sensory block with hyperbaric bupivacaine spinal anesthesia. Anesth Pain Med. 2014 12; 4(2): 17939. doi: 10.5812/aapm.17939.

Bergmann I, Hesjedal B, Crozier TA. et al. Selective unilateral spinal anaesthesia for outpatient knee arthroscopy using real-time monitoring of lower limb sympathetic tone. Anaest Intensive Care. 2015; 43(3):351-6.




Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2019

 

   Seo анализ сайта