Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty

Egmond, Jeroen C van; Verburg, Hennie; Derks, Eveline A.; Langendijk, P. N. J.; Içli, Caner; Dasselaar, Nick T. van; Mathijssen, Nina M C

doi:10.1007/s12630-018-1165-4

Cited by 9 publications

(10 citation statements)

References 36 publications

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“…Pushes for lower dosing have yielded inconsistent results for certain procedures [ 18 , 19 ]. The disadvantages of smaller doses, namely, late-onset sensory block, short duration of action, intraoperative pain and extremity movement during surgery, and sometimes severe postoperative hypotension, have slowed advances in this area, and as such, there remains a debate over optimal dosing, despite one study showing that for TKA with operative times around 100 minutes, only 5 mg of bupivacaine is effective [ 20 ]. Hyperbaric bupivacaine is another alternative, but is not commonly used in our institution for orthopedic procedures, and is more often used in the obstetric setting, although a recent Cochrane review shows that the choice of isobaric vs hyperbaric bupivacaine is also debatable in that setting [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

et al. 2021

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Background The choice of anesthesia plays a significant role in the success of total joint arthroplasty (TJA). Isobaric bupivacaine spinal anesthesia is often used. However, dosing of bupivacaine has not been extensively studied and is usually at the discretion of the treating anesthesiologist and surgeon. The goal of this study was to determine what, if any, effect the dose of bupivacaine spinal anesthesia had on perioperative outcomes in TJA. Methods A total of 761 TJAs performed with bupivacaine spinal anesthesia by arthroplasty surgeons were retrospectively reviewed. Perioperative outcomes evaluated were operation duration, estimated blood loss, length of stay (LOS) in the postanesthesia care unit, hospital LOS, discharge disposition, episodes of intraoperative hypotension, postoperative nausea and vomiting, and missed physical therapy sessions because of postoperative symptoms of hypotension. A Student’s t-test was used for continuous variables, and a chi-squared test was used for categorical variables. Results Of the 761 patients, 499 (65.6%) received 15 mg isobaric bupivacaine while 262 (34.4%) received <15 mg (range = 7.5-14.5 mg, median = 12.5 mg). With the numbers available in this cohort, lower doses of bupivacaine were not associated with any significant differences between groups for any of the studied perioperative outcomes, including proportion of patients discharged home or LOS. Conclusion Dosage of bupivacaine spinal anesthetic did not affect perioperative outcomes. Bupivacaine may not have a dose-related response curve in this regard, and if seeking to perform same-day or outpatient TJA, other agents may need to be considered, rather than smaller doses of bupivacaine.

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Section: Introductionmentioning

confidence: 99%

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

et al. 2021

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“…In this setting, intrathecal administration of 20 to 60 mg has been described 10,11,12,13,14,15 . Unlike hyperbaric prilocaine or bupivacaine the ED 95 of plain 2-chloroprocaine for lower limb surgery is currently unknown 16,17 . Determination of the ED 95 is usually obtained from a population of patients without specific selection criteria.…”

Section: Introductionmentioning

confidence: 99%

“…10,11,12,13,14,15 Unlike hyperbaric prilocaine or bupivacaine the ED 95 of plain 2-chloroprocaine for lower limb surgery is currently unknown. 16,17 Determination of the ED 95 is usually obtained from a population of patients without specific selection criteria. However, amongst other factors, the height of the patient could influence the level and the duration of sensory and motor blocks and therefore modify the ED 95 .…”

Section: Introductionmentioning

confidence: 99%

Influence of height on ED95 of intrathecal 2-chloroprocaine for knee arthroscopy

Guntz

Jeanne

Gouwy

et al. 2022

European Journal of Anaesthesiology

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BACKGROUND Plain 2-chloroprocaine , a rapid acting amino-ester-type local anaesthetic, is used in short ambulatory procedures under spinal anaesthesia. The ED 95 of 2chloroprocaine for lower limb surgery has not yet been defined. Moreover, patients' body height could influence the effects of the administered dose.OBJECTIVES The aim of this study was to determine the ED 95 of plain 2-chloroprocaine based on the height of patients undergoing ambulatory knee arthroscopy under spinal anaesthesia using the continual reassessment statistical method (CRM).DESIGN Prospective, dose-response, double blind, controlled, bi-center, clinical trial.SETTING One university teaching hospital in Brussels and one general teaching hospital, Braine l'Alleud, Belgium. Universit e libre de Bruxelles, PATIENTS ASA I-III (120 patients) scheduled for day-case knee arthroscopy under spinal anaesthesia INTERVENTIONS Patients were divided into three groups of 40, each comprising 10 cohorts of 4 patients, according to their respective heights (Group 1: 150-165 cm, Group 2: 166-180 cm, Group 3: 181-195 cm). Each patient enrolled into one of the 3 groups received an intrathecal dose of plain 2-chloroprocaine determined by the CRM. The starting doses for the first cohorts of four were 40 mg in group 1, 45 mg in group 2 and 50 mg in group 3. The doses for subsequent cohorts were determined by CRM of outcomes in all patients in the previous competed cohorts. Anaesthesia was considered successful when there was a lack of pinprick or cold sensation up to T12, the visual analogue scale score for tourniquet pain was < 2 and no pain during surgery.MAIN OUTCOMES The primary outcome was the success or failure of the block. Side effects were also recorded.RESULTS ED 95 of 2-chloroprocaine is 40 mg in group 1, 35 mg in group 2, 45 mg in group 3. Groups were different in terms of height and gender (P < 0.05) and similar in terms of body mass index and age (P > 0.05).CONCLUSION The ED95 of intrathecal 2-chloroprocaine for patients undergoing ambulatory knee arthroscopy is between 35 and 45 mg. Height could be a factor involved in the calculation, and patient sex could partly explain the nonlinear relation between height and dose.

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“…Bupivacaine is one of the most common options for spinal anaesthesia in total hip (THA) or total knee (TKA) arthroplasty. It produces a well-known dose-dependent long-acting anaesthesia and analgesia, associated with postoperative urinary retention and delayed motor function recovery, which have led to multiple studies looking for a minimally effective dose, with non-compromising anaesthesia safety and fast-track protocols [ 3 , 4 ]. However, even lower doses of bupivacaine were not constantly associated with a significant improvement in the term of events, precluding the meeting of fast-track protocol requirements [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty—Consecutive Case Series Study

Alhefeiti

Patrascu

Lustig

et al. 2022

JCM

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Spinal anaesthesia is an established component of perioperative management for fast-track lower limbs arthroplasty. Short-acting local anaesthetics may present an interesting option for primary non-complicated knee (TKA) and hip (THA) arthroplasty. We describe the perioperative outcomes in patients operated under fixed 50 mg spinal chloroprocaine for total hip and knee replacement. In this retrospective case series study, 65 patients were analysed (median age 65 years, 55% females, benefit from THA (n = 31), TKA (n = 25), and unicompartmental knee arthroplasty (n = 9)). In all cases, anaesthesia duration (87 min) was sufficient for successful surgery (52 min). Up to 45% of patients (THA and less in TKA) developed postoperative pain in the post-anaesthesia care unit (PACU), requiring intravenous morphine titration (up to 7.5 mg). One patient developed severe breakthrough pain requiring advanced regional analgesia. The median PACU stay was up to 97 min (less in TKA), and the incidence of nausea and urinary retention was low. All patients were able to start physical therapy on the same day of surgery. These findings encourage the use of a short-acting agent for spinal anaesthesia in patients with primary non-complicated arthroplasty; however, the relay analgesia should be systematically implemented to avoid breakthrough pain in PACU.

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Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty

Cited by 9 publications

References 36 publications

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty

Influence of height on ED95 of intrathecal 2-chloroprocaine for knee arthroscopy

Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty—Consecutive Case Series Study

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