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  • Title: Hemodynamic effects of continuous spinal anesthesia: a comparative study between low and high doses of bupivacaine.
    Author: Labaille T, Benhamou D, Westermann J.
    Journal: Reg Anesth; 1992; 17(4):193-6. PubMed ID: 1515383.
    Abstract:
    BACKGROUND AND OBJECTIVE: Arterial hypotension is a major side effect of spinal anesthesia. Continuous spinal anesthesia may allow titration of the amount of local anesthetic to obtain a level that is appropriate for the surgical procedure. METHODS: This study compared the hemodynamic effects and the quality of analgesia of spinal anesthesia performed with 3 ml of either 0.125% (n = 12) or 0.5% (n = 13) plain bupivacaine in 25 elderly patients undergoing orthopedic surgery. RESULTS: The initial dose's duration of action (time elapsed between the end of injection and the first patient's complaint of pain during surgery) was shorter in the group receiving 3 ml of 0.125% plain bupivacaine than in the group receiving 0.5% plain bupivacaine: 80 +/- 31 minutes versus 114 +/- 37 minutes, respectively (mean +/- SD; p less than 0.05). In 6 (50%) of 12 patients of the 0.125% group and in 2 (15%) of 13 of the 0.5% group, analgesia became insufficient during the surgical procedure, necessitating injection of an additional 1 ml (top-up) of the previous solution. All subjects obtained good anesthesia for the entire procedure. The mean dose of bupivacaine necessary for the procedure was significantly lower in the 0.125% group (4.8 +/- 1.3 mg) compared with the 0.5% group (16.1 +/- 3 mg). For a similar maximal upper level of analgesia (T4-T12 in the 0.125% group versus T2-T10 in the 0.5% group), the decrease in systolic arterial pressure was more pronounced in the 0.5% group than in the 0.125% group during the period 15-40 minutes after induction of spinal anesthesia (p less than 0.05%). The mean dose of ephedrine was threefold larger in the 0.5% group than in the 0.125% group. CONCLUSION: Continuous spinal anesthesia with small amounts of 0.125% plain bupivacaine produces effective anesthesia for orthopedic procedures in elderly patients with minimal hemodynamic changes.
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