Advantages of Lateral Injection of Hyperbaric Bupivacaine in Spinal Anesthesia for Orthopedic Surgery

Abstract

Abstract. The use of spinal anesthesia is the most frequent method of analgesia, therefore prolonging the duration of anesthesia and increasing its safety is a priority during operations on the lower extremities.
 The aim of the study: to extend the duration of the sensory block during spinal anesthesia, ensuring its safety for the patient.
 Materials and methods. To conduct the study, we analyzed the use of spinal anesthesia during surgical interventions in traumatology and orthopedics in 50 patients, divided into two study groups. The 1st research group (control) included 25 patients (18 men, 7 women) who underwent spinal anesthesia with the recommended graded dose of local anesthetic according to the patient's height, followed by supine position for up to 20 minutes. The II study group included 25 patients (17 men, 8 women) who underwent spinal anesthesia with a dose of local anesthetic determined by the height of the patient, followed by lateral position for up to 20 minutes.
 The results. The duration of the sensory block in patients of the I group was 252.2±74.32 min., and in the II – 299.2±62.44 min. respectively (р = 0.0193). During the assessment of SBP and heart rate in both study groups, a decrease in mean arterial pressure and heart rate after spinal anesthesia was determined, which was more pronounced during spinal anesthesia with subsequent application to the back. The volume of crystalloid infusion therapy during surgery was compared in both study groups. In patients of the I group, it was 2042±663.9 ml, and in the II group – 2028±600.36 ml. (p=0.938, the comparison was made according to the Student's test). The frequency of use of phenylephrine (for correction of hypotension with SBP < 65 mmHg) in the I group was 0.092±0.016 ml, in the II group – 0.004±0.002 ml. (p – 0.018, the comparison was carried out according to the Mann-Whitney test). Atropine sulfate was used to correct bradycardia (heart rate <50 beats/min), in group I – 0.16±0.031 ml, in group II – 0.14±0.034 ml. (p – 0.587, the comparison was carried out according to the MannWhitney test).
 Conclusions. 1. Selection of the dose of hyperbaric bupivacaine depending on the height of the patient ensures the necessary effectiveness of spinal anesthesia. 2. The duration of motor and sensory blockade is significantly higher by 16 % in the group with the lateral position of the patient. 3. When using a hyperbaric local anesthetic for spinal anesthesia in the lateral position, the frequency of cardiovascular complications decreases compared to the control group