Restrictive (5 ml/kg) and liberal (10 ml/kg) preload in unilateral spinal anesthesia with low-dose hyperbaric bupivacaine (5 mg) for arthroscopic knee surgery
Keywords:anesthesia, knee joint, arthroscopy
Background. In arthroscopic knee surgery, unilate-ral spinal anesthesia with low-dose hyperbaric bupivacaine is used. In case of unilateral block, one should pay special attention to the prevention of hypotension. One of such prophylactic measures is preload with fluids. Restrictive preload decreases amount of fluid in comparison with liberal preload. Search for adequate volume of preload, which can prevent hypotension, maintain hemodynamic stability and provide fast hospital discharge in unilateral spinal anesthesia with low-dose bupivacaine for arthroscopic knee surgery, is continuing. Materials and methods. Thirty patients scheduled for arthroscopic knee surgery were divided into 2 groups. Group 1 (n = 15) with libe-ral preload received 10 ml/kg of 0.9% normal saline 15 min before unilateral spinal anesthesia with low-dose bupivacaine. Group 2 (n = 15) with restrictive preload received 5 ml/kg of 0.9% normal saline 15 min before unilateral spinal anesthesia with low-dose bupivacaine. Hemodynamic data in perioperative period were evaluated. Results. There were no cases of hypotension at any stage of investigation. Under spinal anesthesia, while placing patients on the back 15 min before starting the ope-ration, a significant decrease in systolic (105.2 ± 4.3* mmHg vs 116.4 ± 4.6 mmHg in groups 2 and 1, respectively; *p < 0.05) and diastolic blood pressure was observed in group 2 (66.7 ± 3.7* mmHg vs 78.1 ± 3.2 mmHg in groups 2 and 1, respectively; *p < 0.05). Start of operation was followed by a decrease in systolic blood pressure in group 2 (103.7 ± 5.1* mmHg vs 121.5 ± 6.5 mmHg in groups 2 and 1, respectively; *p < 0.05). Faster restoration of voiding (128.7 ± 12.3* min vs 157.2 ± 16.6 min; *p < 0.05 in groups 2 and 1, respectively) allowed for a faster hospital discharge (152.7 ± 14.2* min vs 178.5 ± 15.5 min in groups 2 and 1, respectively; *p < 0.05). Conclusions. The use of liberal (10 ml/kg) preload prevents development of hypotension, preserves stable hemodynamics in perioperative period, provides early voiding and fast hospital discharge in unilateral spinal anesthesia with low-dose hyperbaric bupivacaine for arthroscopic knee surgery. The use of restrictive (5 ml/kg) preload prevents development of hypotension, leads to labile hemodynamics in early stages of anesthesia, provides earliest voiding and fastest hospital discharge in unilateral spinal anesthesia with low-dose hyperbaric bupivacaine for arthroscopic knee surgery.
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