Spinal Anesthesia Using 0.75 % Hyperbaric Levobupivacaine for Outpatient Knee Arthroscopy: Randomized Double-Blind Study Comparing Three Different Doses
Objetive. To assess the probability of motor block through time by means of a comparison between three doses of 0.75 % hyperbaric levobupivacaine (HLBP) using a unilateral spinal technique.
Methodos. 180 ASA I-II patients between 18 and 60 years of age scheduled for unilateral knee arthroscopy were randomized prospectively to receive 7.5 mg (n = 59), 9.37 mg (n = 61) and 11.25 mg (n = 60) of 0.75 % HLBP through a 27-gauge Whitacre needle, and were left in a lateral decubitus position for five minutes. An independent observer assessed the level of motor and sensory block after returning to the supine position, at the end of surgery, and every ten minutes in the PACU until discharge.
Results. There were no diferences in demographics or failure rates among the groups among the groups. The time for complete resolution of the respecmotor block was shorter when 7.5 mg were used (145 ± 49 vs. 156 ± 65 vs. 170 ± 70.5 min, respectively. P = 0,006). Length of stay in the PACU was also shorter (155 ± 45 vs. 178 ± 70 and 184 ± 72 min, respectively, P = 0,004), with no difference in the time periods for the resolution of the sensory block. The probability of block resolution after 200 minutes was significantly higher in the group receiving 7.5 mg [0.95 (95 % CI 0.84 - 0.98) vs. 0.80 (0.67 - 0.88) vs. 0.73 (0.59 - 0.82), respectively. OR: 1.84 (95 % CI 1.28 - 2.64].
Conclusions. The spinal administration of 7.5 mg of 0.75 % HLBP is effective and safe in patients undergoing unilateral arthroscopic procedures of the knee. This reduces length of stay in the recovery room and the duration of the motor block.
2. Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia. Can J Anaesth. 2000;47(8):746-51.
3. Borghi B, Stagni F, Bugamelli S, Paini MB, Nepoti ML, Montebugnoli M, et al. Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study. J Clin Anesth. 2003;15(5):351-6.
4. Kokki H, Ylönen P, Heikkinen M, Reinikainen M. Levobupivacaine for pediatric spinal anesthesia. Anesth Analg. 2004;98(1):64-7.
5. Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care. 2003;31(6):637-41.
6. Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg. 2002;94(1):188-93.
7. Lovo C, Montagna A, D’Angelo L, Volpetti S, Redivo M, Crupi D, et al. La levobupivacaina ipobarica nell’anestesia subaracnoidea in regime di day-surgery: confronto con la bupivacaina. Minerva Anestesiol. 2004;70(6):540-1.
8. Moizo E, Marchetti C, Bergonzi PC, Putzu M, Iemi K, De Luca M, et al. Unilateral spinal anestesia for inguinal hernia repair: a prospective, randomized, double-blind comparison of bupivacaine, levobupivacaine, or ropivacaine. Minerva Anestesiol. 2004;70(6):542-3.
9. Zbinden AM, Maggiorii M, Petersen-Felix, Lauber R, Thomson DA, Minder CE. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia: I. Motor reactions. Anesthesiology. 1994;80(2):253-60.
10. McDonald SB, Liu SS, Kopacz DJ, Stephenson CA. Hyperbaric spinal ropivacaine. A comparison to bupivacaine in volunteers. Anesthesiology. 1999;90(4):971-7.
11. Nair GS, Abrishami A, Lermitte J, Chung F. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth. 2009;102(3):307-15.
12. Casati A, Moizo E, Marchetti C, Vinciguerra F. A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg. 2004;99(5):1387-92.
13. Brun-Buisson V, Bonnet F, Liu N, Delaunay L, Saada M, Porte F, et al. Analysis of failures of spinal anesthesia as a function of practice development in a university hospital. Ann Fr Anesth Reanim. 1991;10(6):539-42.
14. Brun-Buisson V, Bonnet F, Boico O, Saada M. Failure of spinal anesthesia. Evaluation of the practice at a university hospital. Ann Fr Anesth Reanim. 1988;7(5):383-6.
15. Schneider MC, Hampl KF, Kaufmann M. Transient neurologic toxicity after subarachnoid anesthesia with hyperbaric 5% lidocaine. Anesth Analg. 1994;79(3):610.
16. Ackerman WE 3rd. Transient neurologic toxicity after subarachnoid anesthesia with hyperbaric 5% lidocaine. Anesth Analg. 1993;77(6):1306.
17. Cappelleri G, Aldegheri G, Danelli G, Marchetti C, Nuzzi M, Iannandrea G, et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study. Anesth Analg. 2005;101(1):77-82.
18. Voelckel WG, Kirchmair L, Rehder P, Garoscio I, Krappinger D, Luger TJ. Unilateral anesthesia does not affect the incidence of urinary retention after low-dose spinal anesthesia for knee surgery. Anesth Analg. 2009;109(3):986-7.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.