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Unilateral spinal anesthesia with low dose bupivacaine and ropivacaine: hypobaric or hyperbaric solutions with fentanyl for one- day surgery?

Background and Objectives: The purpose of this study was to compare the quality of unilateral spinal anesthesia with low dose bupivacaine and ropivacaine deluded in different baric solutions (hyperbaric / hypobaric). In our special interest was to define possibilities to use hypobaric solutions of local anesthetics if they prove to have any advantages. Methods : This prospective study was conduced over a 24-month period, enrolling eighty patients (ASA groups I, II, III) randomly divided into four groups. The study solution (5mg of 0.5% bupivacaine or 5 mg 1.0% ropivacaine with 25mcg fentanyl, prepared in a different baric solution (hyperbaric / hypobaric)) were injected into the subarachnoidal interspaces at the level L2-L3/L3-L4. After the inducing spinal anesthesia, the patients in the hyperbaric groups kept the lateral decubitus position with the operated side facing down ; while the patients in the hypobaric groups kept lateral decubitus position facing the operated side up. During the set time intervals we evaluated how rapid was the beginning and the regression of the unilateral block ; the extension of the motor and the sensoric block, the haemodinamic changes and the home admition time. Results: All of the patients included in the study tolerated the procedure well. The median time for achieving the unilateral surgical anesthesia was the shortest in hyperbaric ropivacaine group (6.95 minutes). The maximal degree of the motor block (Bromage 3) was the highest in the hyperbaric bupivacaine group. The median recovery time to be able to walk and to the first urine pass was faster achieved in the hyperbaric and hypobaric ropivacaine groups (160 minutes vs.190 minutes), comparing to the hyperbaric and hypobaric bupivacaine groups (230 minutes vs.250 minutes). Side–effects were minor and infrequent in all groups. Conclusions: According to this study the baricity of the anesthetic solution has no influence in achieving successful unilateral spinal block. Ropivacain will be chosen if we want to realize a faster readiness to surgery, and a faster recovery with few side-effects and complications ; all particularly appreciable in an outpatient surgery.

unilateral spinal anesthesia ; bupivacaine ; ropivacaine ; hyperbaric ; hypobaric ; one-day surgery

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