The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine

Abstract

SummaryIn this study, we aimed to test the hypothesis that 1-ml plain solution of 0.5% bupivacaine or 0.5% levopubivacaine administered in a subarachnoid block can provide adequate anaesthesia and operating conditions for pilonidal cyst ⁄ sinus operations performed in the prone position. There were no significant differences between the two groups in terms of patient demographic data, duration of operation, patient-surgeon satisfaction, haemodynamic changes and side effects. There were no significant differences found in the onset time, highest block level achieved, two segment regression, time to S 2 regression of sensory block and the number of anaesthetised dermatomes, between the two groups (p = 0.077, 0.057, 0.091, 0.084 and 0.057 respectively). The incidence of complete motor blockade was 16% and 8% in Group B at the start and at the end of the operation. There was no complete motor blockade in Group L (p = 0.110 and 0.490 respectively). We conclude that both regimens are effective and safe for use in subarachnoid anaesthesia for pilonidal cyst ⁄ sinus operations performed in the prone position.

A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean section: prospective, double-blinded study

“…As all of the groups received opioid, we found that onset and maximum cephalic spread times were similar among the groups, while maximum sensory block height was greater in group 10. The motor block was more intensive in groups that had a higher dose of local anesthetic, as expected since the lower incidence of complete motor block was related to the lower dose of local anesthetic used [24]. In addition, the epidural supplements may prolong motor and sensory block at the end of the procedure [21,25].…”

A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery

“…In our study, spinal anesthesia was performed with the patient in the left lateral decubitus position, and after injection, patients turned to the supine position immediately, and then all patients were put into the prone position. In Cuvas's [6] study, which was also performed in the prone position, the characteristics of sensory and motor blocked were similar in the bupivacaine and levobupivacaine groups. But they used low- dose isobaric local anesthetic and spinal anesthesia was performed with the patient in sitting position and operations performed in the standard prone position.…”

“…Hyperbaric local anesthetic solutions are generally used in spinal anesthesia, but in the prone position, it may cause the spread of the local anesthetic solution in a cephalic direction and produce motor blockade in the anterior roots of the thoracic region, leading to ventilatory depression [6]. In the prone position, local anesthetic concentration in the anterior spinal segments increases over time and motor blockade also increases.…”

Bupivacaína 0,15% hipobárica versus lidocaína 0,6% hipobárica para raquianestesia posterior em cirurgia anorretal ambulatorial

“…Spinal block is associated with lower rate of side effects and better cost/benefit ratio than general anesthesia, and it is well accepted by patients 3 . Unlike 5 mg of isobaric solution (bupivacaine/levobupivacaine) that produces complete motor blockade in 15% of the patients 19 , the hypobaric solution (bupivacaine/lidocaine) does not cause the same; motor blockade was not observed in 90% of the patients. To conclude, spinal block with hypobaric bupivacaine (4.5 mg) or lidocaine (18 mg) was effective and safe in anorectal surgeries and preserved motor function.…”