Introduction: Many factors have been tested to predict the spread of spinal anesthesia in clinical practice. In the study we aimed to investigate the correlation between hip/shoulder width ratio and spread of spinal anesthesia.Method: Sixty patients were enrolled in this study to determine the correlation between hip/shoulder width ratio and the spread of spinal anesthesia. The L4-L5 interspace, navigated by ultrasonography, was introduced at lateral position with a 25G spinal needle. 3ml 0,5% hyperbaric bupivacaine was injected intrathecal in 15 seconds. Age, height, weight, body mass index, hip/shoulder width ratio and vertebral column length were recorded. Spinal anesthesia spread was assessed at 0, 5, 10, 20, and 30 minutes after spinal anesthesia. Patient was turned supine 5 minutes after intrathecal injection. Multiple linear regression analysis was used to analyze correlation between the spread of spinal anesthesia and age, height, weight, hip/shoulder width ratio, vertebral column length.Results: The study was completed without dropout and sixty participants were included into analysis. There was a strong correlation between the spread of spinal anesthesia and hip/shoulder width ratio (r=0,766; p<0,0001) and a negative correlation with the height and vertebral column length (r= -0,572; -0,738 and p=0, 000; 0, 000 respectively).Conclusion: Cephalad spread of spinal anesthesia with a fixed dose of hyperbaric bupivacaine is strongly correlated with hip/shoulder width ratio and inversely correlated with height and vertebral column length. We may observe more spread with 0, 5% hyperbaric bupivacaine in patients with a greater hip/shoulder ratio and a shorter height.

No abstract

Objectives This study aims to evaluate the effects of two different doses of intraarticular ketamine on visual analog scale (VAS) scores at rest and movement, time to first analgesic requirement, and 24-h morphine consumption in patients undergoing arthroscopic meniscectomy as well as to assess the frequency of postoperative nausea&vomiting, respiratory depression, pruritus, urinary retention, and constipation and to compare the time to discharge. Patients and methods This prospective randomized double- blind study was performed between August 2013 and August 2014 on 75 patients (32 males, 43 females; mean age 46.7±13 years; range, 18 to 75 years) with American Society of Anesthesiologists scores of I-II scheduled for unilateral meniscectomy. Patients were randomized to receive 0.5 mg.kg -1 ketamine (group K1), 1 mg.kg -1 ketamine (group K2) or saline (group S) to a total volume of 20 mL intraarticularly at the end of the surgery. All patients were performed periarticular 10 mL 0.5% bupivacaine infiltration. Visual analog scale at rest and during passive knee movement was used to evaluate pain both preoperatively and at postoperative 0, 30 min, and 1, 2, 4, 6, 12, and 24 h. Time to first analgesic requirement and morphine consumption were recorded. Results Visual analog scale scores at rest and during movement at postoperative 0 were significantly reduced in group K2 compared with group S (p<0.05). The first analgesic requirement time was significantly longer in group K1 (76.9±25.2 min) and group K2 (93.4±26.1 min) than group S (29.3±7.1 min). Morphine consumption was lower in group K2 compared to group K1 and group S at postoperative 30 min, and 1 and 2 h. However, 24-h morphine consumption was similar in all groups. Conclusion Intraarticular injection of 0.5 mg.kg -1 and 1 mg.kg -1 ketamine for postoperative pain management provided similar analgesic efficacy. However, high dose ketamine more noticeably decreased opioid requirement in the early postoperative period.

Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.

Addition of fentanyl to lidocaine IVRA seems to be superior to lidocaine IVRA and lornoxicam added to lidocaine IVRA groups in decreasing tourniquet pain at the expense of increasing side effects. However, lornoxicam did not increase side effects while providing intraoperative and postoperative analgesia. Therefore, lornoxicam could be more appropriate for clinical use.