Patient Variables Influencing the Sensory Blockade Level of Spinal Anesthesia Using Hyperbaric Bupivacaine in Term Parturients

2003 ◽  
Vol 45 (5) ◽  
pp. 627 ◽  
Author(s):  
Eun Ju Kim ◽  
Ji Hyang Lee ◽  
Jong Suk Ban ◽  
Byung Woo Min
Keyword(s):  
Spinal Anesthesia ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Patient Variables ◽  
Blockade Level

scholarly journals A comparative clinical study of intrathecal hyperbaric bupivacaine with and without fentanyl for hysterectomy

2020 ◽  
Vol 11 (2) ◽  
pp. 59-63
Author(s):  
Hari Poudel ◽  
Surinder Nath Bawa ◽  
Surendra Mohan Sharma
Keyword(s):  
Side Effects ◽  
Spinal Anesthesia ◽  
Sensory Block ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Maximum Height ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Group I ◽  
Group Ii

Background: Spinal anaesthesia has been widely used for lower abdominal surgeries like hysterectomy.Hyperbaric bupivacaine is the most extensively used local anesthetic. Addition of fentanyl can allow the reduction in the dose of bupivacaine, increase the height and duration of sensory blockade, and reduces complications of spinal anesthesia. Aims and Objective: The aim of the study was to examine whether adding fentanyl to hyperbaric bupivacaine would increase the height of sensory blockade, accelerate the onset of sensory blockade and increase the duration of the sensory blockade. Material and Methods: This study was done in Manipal Teaching Hospital, Pokhara, Nepal that included hundred patients who underwent total abdominal hysterectomy. The patients were randomly allocated in two groups; Group I: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus normal saline 0.5 ml. Group II: received 0.5% hyperbaric bupivacaine 2.5 ml (12.5 mg) plus 0.5 ml fentanyl (25 μg). Hemodynamic variables, onset of motor and sensory blockade, duration of sensory and motor blockade and any side effects were observed and recorded. Results: The highest and lowest sensory block in Group I was T-7 and T-9 whereas in Group II was T-5 and T-9 respectively. In group I, the mean onset till maximum height of sensory blockade was 7.04 min whereas in group II it was 5.96 min (P<0.00).There was no significant statistical difference in the incidence of side effects in both the groups. Conclusion: Intrathecal fentanyl with hyperbaric bupivacaine for spinal anesthesia significantly accelerated the onset of sensory blockade and increased its maximum height and duration.

scholarly journals Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

2009 ◽  
Vol 127 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Luiz Eduardo Imbelloni ◽  
Marildo Assunção Gouveia ◽  
José Antonio Cordeiro
Keyword(s):  
Clinical Study ◽  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Motor Blockade ◽  
Continuous Spinal Anesthesia ◽  
Sensory Blockade ◽  
Combined Spinal Epidural ◽  
Major Orthopedic Surgery ◽  
Spinal Epidural ◽  
Blockade Level

CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

scholarly journals Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

2017 ◽  
Vol 4 (6) ◽  
pp. 1653
Author(s):  
Amitha S. ◽  
Pradeep R.
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Double Blind ◽  
Sensory Blockade ◽  
Exact Test ◽  
Interlocking Nailing ◽  
Group 3

Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia.Methods: The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant.Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups.Conclusions: We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

scholarly journals COMPARISON OF TWO LOW DOSE REGIMENS OF SUBARACHNOID BLOCK ANESTHESIA FOR LOWER SEGMENT CAESARIAN SECTION

2020 ◽  
pp. 1-4
Author(s):  
Manoj Kumar Mishra ◽  
Sunny Eapen
Keyword(s):  
Spinal Anesthesia ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fixed Dose ◽  
Gravid Uterus ◽  
Tertiary Care Centre ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Induced Hypotension ◽  
Perioperative Analgesia

Hypotension and bradycardia due to sympathetic blockade are two commonest complications of spinal anesthesia leading to maternal and neonatal morbidity and mortality. Aorto caval compression due to gravid uterus also contributes to the development of hypotension. Wedge under right buttock to provide 250 sideways tilt is used to prevent aortocaval compression by gravid uterus.Low dose bupivacaine heavy with intrathecal fentanyl is recommended as strategy to prevent spinal anesthesia induced hypotension and related complications. The present study was done in our tertiary care centre to compare the effects of fixed dose of Fentanyl 20μg (0.4ml) administered along with two low doses 1.6 ml(8mg) and 1.8 ml(9mg) of 0.5% hyperbaric bupivacaine (heavy) and assess the adequacy of surgical anaesthesia for caesarean section and hemodynamic changes intra operatively. There was faster onset of sensory blockade, better haemodynamic stability and prolonged postoperative analgesia in patients administered with1.6ml of 0.5% Bupivacaine heavy (8mg) & 20μg Fentanyl (Gp I) compared with patients administered with 1.8ml of 0.5% Bupivacaine heavy (9 mg) & 20μg Fentanyl (Gp II) . Perioperative analgesia was excellent in both the groups. No patient who developed bradycardia or hypotension in Gp I and only 2 patients in Gp II developed hypotension.Post-operative analgesia was for a longer period in Group II as compared to Gp I.

Extent of Hyperbaric Spinal Anesthesia Influences the Duration of Spinal Block

2000 ◽  
Vol 92 (5) ◽  
pp. 1319-1323 ◽  
Author(s):  
Nicoline E. Kooger Infante ◽  
Elizabeth Van Gessel ◽  
Alain Forster ◽  
Zdravko Gamulin
Keyword(s):  
Spinal Anesthesia ◽  
Spinal Block ◽  
Sensory Level ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Operative Site ◽  
Lower Limb Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

Background The influence of spread of spinal anesthesia on the duration of spinal blockade has been suggested but never investigated specifically. Because elimination of local anesthetic from subarachnoid space is probably dependent of the surface available for its diffusion and vascular absorption, the current study was designed to evaluate the hypothesis that with a same dose of hyperbaric bupivacaine, a higher anesthetic level would result in a shorter duration of spinal blockade than a lower level. Methods Three milliliters (15 mg) of hyperbaric bupivacaine, 0.5%, was injected intrathecally in 40 patients classified as American Society of Anesthesiologists physical status I or H scheduled for lower limb surgery during spinal anesthesia. To obtain significantly different anesthetic levels, the patients were positioned randomly either horizontally or with the torso elevated 30. Regression of sensory level and motor blockade, the appearance of pain at the operative site, and hemodynamic changes were evaluated. Results The maximum cephalad spread of sensory blockade (expressed as the median with ranges in parentheses) was significantly higher in the horizontal group than in the group with 30-degree elevation of the torso, i.e., T3.5 (T1-T9) versus T10 (T6-L1), with respectively significantly faster regression times (mean ¿ SD) by two segments (216 ¿ 46 mm vs. 253 ¿ 64 mm) and to segment L4 (269 ¿ 53 mm i s. 337 ¿ 58 mm), as well as shorter time to complete motor blockade recovery (173 ¿ 34 mm i s. 233 ¿ 58 mm) and faster appearance of pain at the operative site (221 ¿ 68 mm vs. 271 ¿ 56 mm). Conclusion The results indicate that with the same dose of hyperbaric bupivacaine, the duration of spinal blockade is longer in patients with restricted spread.

A study of intrathecal low dose bupivacaine and fentanyl versus conventional dose of bupivacaine alone for elective caesarean section

2021 ◽  
Vol 19 (3) ◽  
pp. 86-90
Author(s):  
Rama Rao V M ◽  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Sensory Block ◽  
Rapid Onset ◽  
P Value ◽  
Sensory Level ◽  
Lipid Solubility ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade

Background: Spinal anesthesia is the most common method of the regional block in cesarean section, because it is easy to perform, economical produces rapid onset of anesthesia, and good muscle relaxation, and most importantly, it gives immense pleasure to the conscious mother. To improve the quality of subarachnoid block, intrathecal opioids are used as adjuvants to Bupivacaine. Fentanyl has a rapid onset of action as a lipophilic opioid following intrathecal administration. Because of high lipid solubility, it undergoes rapid uptake by the spinal cord, and hence the chances of delayed respiratory depression are less. Methods: We randomly selected 60 patients belonging to the American Society of Anesthesiologists (ASA) class I and II, who are scheduled for elective LSCS. These patients were divided randomly into two groups of 30 each. Group B received 10mg of 0.5% hyperbaric bupivacaine (2ml). Group BF received 7.5mg of 0.5% hyperbaric bupivacaine (1.5ml) with 25mcg of Fentanyl (0.5ml). Lumbar puncture was performed at the level of L3-L4 with 23 Guage Quincke Babcock's needle with the patient in the right lateral position. The sensory block was assessed with the loss of pin prick sensation, and the motor block was set using the Bromage scale technique. We also recorded the hemodynamic parameters like pulse rate, blood pressure, oxygen saturation. Results: No significant statistical difference was found in demographic data between the two groups. Group BF showed early onset of the sensory block with a P value of 0.001. Time taken to attain peak sensory level was early in the BF group with a P value of 0.001. The total duration of sensory block and duration of effective analgesia was longer in the BF group with a P value of 0.001. The onset of motor blockade was early in the bupivacaine only group with a P value of 0.02. Conclusion: The intrathecal fentanyl 25mcg reduces the dose of 7.5 mg of 0.5% hyperbaric Bupivacaine for spinal anesthesia in cesarean section, thus reducing the incidence of side effects associated with it. By its synergistic effect with 0.5% hyperbaric bupivacaine, it provides better excellent sensory blockade and postoperative analgesia, good hemodynamic stability, less incidence of complications like Nausea, vomiting, and shivering without compromising the safety of mother and fetus in comparison to intrathecal 10mg of 0.5% hyperbaric Bupivacaine alone.

Minor Factors Influencint to the Sensory Blockade Level of Spinal Anesthesia at the L2, 3 Interspace

1996 ◽  
Vol 30 (3) ◽  
pp. 321
Author(s):  
Tae Hyun Lee ◽  
Woon Seok Roh ◽  
Bong Il Kim ◽  
Jin Woong Park
Keyword(s):  
Spinal Anesthesia ◽  
Sensory Blockade ◽  
Blockade Level

scholarly journals SPINAL ANESTHESIA

2016 ◽  
Vol 23 (02) ◽  
pp. 161-165
Author(s):  
Hamid Raza ◽  
Bashir Ahmed ◽  
Kamlaish Kamlaish ◽  
Saqib Basr ◽  
Ahmed Ali
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Motor Blockade ◽  
Lower Segment ◽  
Hemodynamic Changes ◽  
Hyperbaric Bupivacaine ◽  
Sensory Blockade ◽  
Lower Segment Cesarean Section ◽  
Group A ◽  
Group B

Objective: The purpose of the study is to compare and assess the sensoryand motor block along with the associated hemodynamic changes that occur in the patientpopulation operated for a lower segment cesarean section (LSCS), when they are given 0.5%hyperbaric bupivacaine versus 0.5% isobaric bupivacaine as used for spinal anesthesia.Study Design: Prospective double blind randomized trial. Period: 6 months duration fromApril 2014 to September 2014. Setting: A tertiary care hospital in the city of Karachi, Pakistan.Method: The study population consisted of 60 patients belonging to the ASA 1 and ASA 2category, who underwent a lower segment cesarean section, and comparative analysis ofthe efficacy and associated hemodynamic changes of hyperbaric with isobaric bupivacaine.The patient population was segmented into two groups both groups containing 30 patients,group A receiving hyperbaric bupivacaine 0.5% as 2.5ml ( 12.5mg dose ) and the secondgroup designated as, group B receiving isobaric bupivacaine 0.5% as 2.5ml ( 12.5mg dose)intrathecally. The resultant sensory and motor blockade was determined using pin prick andbromage scale respectively. Results: There was a significant difference found among the twogroups under study, when compared at 3min interval regarding the sensory blockade. The levelof T6 block was reached in 33.33% (n=10) patients belonging to group A and 56.66% (n= 17)patients in group B. It was observed that there was no significant change among the two groupsat 5min interval regarding sensory and motor blockade respectively. The immediate sensoryblockade with isobaric bupivacaine in group B produced greater decrease in the systolic andmean arterial blood pressure when contrasted with hyperbaric bupivacaine in group A at 5mininterval, but after time interval of 45min there was no statistically significant change observed.Conclusions: According to our study the effects of isobaric bupivacaine were more significantlypredictable; hence have a higher efficacy, when contrasted against hyperbaric bupivacainein lower section cesarean section spinal anesthesia. Quick sensory blockade with isobaricbupivacaine was associated with more decrease in blood pressures when contrasted with thehyperbaric bupivacaine, but this result is not statistically significant.

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