Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature

Lui, Anne; Polis, Tomasz Z.; Cicutti, Nicholas

doi:10.1007/bf03012018

Cited by 123 publications

(100 citation statements)

References 15 publications

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“…11 Dextrose-free (plain) solutions of bupivacaine and opioids, usually referred to as being isobaric, are actually hypobaric at body temperature, with a density less than 1.00000 g·mL -1 . 3,[12][13][14] The slight hypobaricity of plain solutions relative to CSF (0.00060 g·mL -1 of difference), could explain the rapid, high sensory block observed after administration of plain local anesthetics and lipid-soluble opioids. 10,11,[15][16][17] Moreover, this pattern of cephalad spread might facilitate the antinociceptive effects of intrathecal opioids through dual activation of spinal as well as supraspinal receptor sites of action, 18 which in turn, might augment the quality of analgesia of plain local anesthetics.…”

Section: Discussionmentioning

confidence: 99%

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Rofaeel

Lilker

Fallah

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: Baricity is an important determinant of block characteristics of the spinal component of a combined spinal epidural (CSE) for labour analgesia. This study compares the analgesic efficacy and side effects of intrathecally administered plain and hyperbaric bupivacaine (both with fentanyl) during active labour.Methods: Sixty-two women in active labour (cervical dilatation ≥ 5 cm and pain score > 5) were randomized in a prospective, single-blinded fashion to receive 2.5 mg of either hyperbaric or plain bupivacaine both combined with 15 µg of fentanyl as the spinal component of a CSE. The primary outcome was failure of satisfactory analgesia within ten minutes of the intrathecal injection as defined by a verbal pain score > 3. Secondary outcomes included need for rescue analgesia, hypotension, respiratory depression, nausea and vomiting, pruritus and sustained fetal bradycardia. Results: Sixty patients were analyzed. The failure rates were 20% in the hyperbaric group vs 0% in the plain group (P = 0.024). The plain solution provided faster onset, higher sensory levels and less motor block at all times during the first 30 min. The incidence of both pruritus and sustained fetal bradycardia was 33% in the plain group and 10% in the hyperbaric group (P = 0.03). Conclusion:A plain rather than hyperbaric solution of bupivacaine 2.5 mg with fentanyl 15 µg provides a faster onset of analgesia, higher sensory levels and less motor block, while demonstrating an increased incidence of pruritus and sustained fetal bradycardia.

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Section: Discussionmentioning

confidence: 99%

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Rofaeel

Lilker

Fallah

et al. 2007

Can J Anesth/J Can Anesth

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“…Intrathecal morphine provides prolonged, good quality postoperative analgesia, while fentanyl has the advantage of decreasing visceral sensation and may prolong the duration of anesthesia. 3,4 In vitro studies examining the effect of adding opioids to local anesthetics have shown morphine to cause minimal change in baricity of the final solution, whereas fentanyl decreases the density of 0.5% bupivacaine by up to 0.0011 g·mL -1 , 5,6 where a difference of as little as 0.0006 g·mL -1 in density alters the movement of local anesthetics in a spinal model. 2 In a more recent study, our group found that the addition of fentanyl to 0.5% bupivacaine made the resultant solution hypobaric within simulated CSF in a spinal model, leading to increased upward spread.…”

Section: Discussionmentioning

confidence: 99%

The addition of fentanyl does not alter the extent of spread of intrathecal isobaric bupivacaine in clinical practice

Patterson

Avery

Chan

et al. 2001

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Fentanyl is commonly added to intrathecal local anesthetic solutions. In vitro data has shown fentanyl to render isobaric local anesthetics hypobaric, and alter the spread in artificial cerebrospinal fluid. This study examined whether the addition of fentanyl to isobaric bupivacaine with morphine leads to a clinically important alteration in the extent of spread of anesthesia.M Me et th ho od ds s: : Forty-four ASA I III patients undergoing lower limb orthopedic procedures completed this double-blind, placebo-controlled trial. Patients were randomized into one of two groups, receiving intrathecal bupivacaine 15 mg and preservative-free morphine 200 µg without (Control group), or with the addition of fentanyl 0.02 mg (Fentanyl group). Patients were maintained at a slight head-up tilt. Variables studied over three hours included sensory level to cold and pinprick, motor blockade (Bromage scale), and circulatory data.R Re es su ul lt ts s: : No differences existed between the Fentanyl and Control groups with respect to highest level of block for cold: T4 (T2 T5) vs T3.5 (T3 T8) respectively (median, 95% confidence interval) or pinprick: T4 (T3 T6) vs T4.5 (T3 T8). Similarly, there was no difference in the time taken to reach maximum block height to cold (20 ± 9 vs 23 ± 13 min, mean ± SD) or pinprick (20 ± 9 vs 24 ± 13 min).C Co on nc cl lu us si io on n: : The addition of fentanyl 0.02 mg to 0.5% bupivacaine with morphine does not affect the maximal block height or time to maximal block in clinical practice.

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“…Nilai densitas cairan serebrospinal akan lebih rendah pada wanita dibandingkan dengan laki-laki, 7 wanita hamil dibandingkan dengan yang tidak hamil, 8 dan wanita premenoupause dibandingkan dengan wanita yang sudah menopause. 9 Menurut teori, perbedaan ini akan menyebabkan perubahan barisitas obat anestesi lokal pada kelompok pasien yang berbeda, tetapi perbedaan itu kecil dan mungkin tidak penting secara klinis. 6 Bupivakain 0,5% hiperbarik merupakan anestetik lokal golongan amino amida yang paling banyak digunakan pada teknik anestesi spinal.…”

Section: Pendahuluanunclassified

Perbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Isobarik dengan Bupivakain Hiperbarik pada Pasien yang Menjalani Operasi Abdomen Bagian Bawah

Longdong¹,

Redjeki²,

Wargahadibrata³

2013

jap

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AbstrakPenyebaran obat anestesi lokal pada anestesi spinal sangat ditentukan oleh barisitas obat anestesi lokal dan posisi pasien. Penelitian ini dilakukan untuk mengetahui perbandingan anestesi spinal menggunakan bupivakain 0,5% isobarik hiperbarik terhadap lama kerja blokade sensoris dan tinggi blokade sensoris pada operasi abdomen bagian bawah. Penelitian eksperimental secara randomized control trial (RCT) pada 40 pasien dengan status fisik ASA I-II, usia 17-60 tahun yang menjalani operasi abdomen bagian bawah di ruang operasi bedah sentral Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari sampai April 2011. Pasien dibagi dalam kelompok isobarik dan kelompok hiperbarik. Tinggi blokade sensoris, lama kerja blokade sensoris dicatat dan dilakukan uji statistik dengan student t-test, chi-kuadrat. Dari hasil penelitian didapatkan lama kerja blokade sensoris pada kelompok isobarik lebih panjang dibandingkan dengan kelompok hiperbarik (242,4 menit SB 28,04 vs 132,95 menit SB 11,33) dengan perbedaan yang bermakna (p<0,001). Tinggi blokade sensoris pada kelompok isobarik lebih rendah dibandingkan dengan bupivakain kelompok hiperbarik. Simpulan dari penelitian ini menunjukkan bupivakain isobarik mempunyai penyebaran lebih rendah dan lama kerja lebih panjang.Kata kunci: Abdomen bagian bawah, analgesia spinal, barisitas ,bupivakain, obat anestesi lokal, teknik anestesi Effectivity of Spinal Anaesthesia Using Isobaric Bupivacaine and Hyperbaric Bupivacaine on Patients Undergoing Lower Abdominal Surgery AbstractDistribution of local anesthetics in spinal anesthesia is most determined by baricity and position. The study was conducted to explore the comparison of effect between spinal anesthesia technique using 0.5% isobaric bupivacaine with 0.5% hyperbaric bupivacaine on duration and level of sensory blocking action in lower abdominal surgery. This experimental study was conducted using randomized control trial (RCT) in 40 patients with physical ASA I-II status, aged 17-60 years, who underwent lower abdominal surgery in central operating theatre Dr. Hasan Sadikin Hospital-Bandung within January to April 2011. The patients were divided into two groups, the hyperbaric group and the isobaric group. The recording included sensory blocking level, sensory blocking duration, and statistical analysis using Student t-test and chi-square test. . Sensory blocking levels in isobaric group were lower than those in hyperbaric group. The conlusion of the study indicates that isobaric bupivacaine has lesser distribution and longer duration of action.

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Densities of cerebrospinal fluid and spinal anaesthetic solutions in surgical patients at body temperature

Cited by 123 publications

References 15 publications

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

The addition of fentanyl does not alter the extent of spread of intrathecal isobaric bupivacaine in clinical practice

Perbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Isobarik dengan Bupivakain Hiperbarik pada Pasien yang Menjalani Operasi Abdomen Bagian Bawah

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