OUR EXPERIENCE USING DIFFERENT BARICITIES OF BUPIVACAINE FOR UNILATERAL SUBARACHNOID BLOCK ANESTHESIA IN DIFFERENT LOWER LIMB ORTHOPEDIC SURGICAL PROCEDURES

Luai K.Aldaklalah MD.*, Mutaz L. Ghabashneh MD., Mohammad Ali Alsuqour MD., Nizar A. A. Abualannaz MD, Mahdi S. A. Jaradat MD.

ABSTRACT

Background: Unilateral subarachnoid block anesthesia uses decreased dosage, low speed of administration and lateral positioning to enhance unilateral drug distribution. Aim: To assess the effect of various baricities of bupivacaine solutions during unilateral subarachnoid block anesthesia in patients scheduled for various lower limb orthopedic surgical techniques. Methods: This prospective, double blind and randomized investigation included 122 patients, of both sexes, aged 33-71 yrs, classed II-III by the American society of Anesthesiologists and assigned for various lower limb orthopedic surgical techniques under unilateral subarachnoid block anesthesia at Prince Rashid military hospital, Irbid, JORDAN, during the year 2016.Patients were grouped in a random fashion into 2 groups. Group I patients were administered subarachnoid 10 mg of 0.5% isobaric bupivacaine solution (2 ml) (Group I, n=61)) or subarachnoid 10 mg of 0.5% hyperbaric bupivacaine solution (2 ml) (Group II, n=61), both in the L3-4 interspace with the patient in the lateral position and keeping such for 15 minutes. Sensory anesthesia was assessed by the pin prick test. Motor blockade was assessed by the Bromage score. Both blockades were compared with the contralateral side. Statistics: Mean age, height and length of the blockade were evaluated by Analysis of Variance, while the level of the sensory and motor blockades was evaluated by the Mood test for medians. The unilaterality of the anesthesia was evaluated by the Chi-square test. P-value less than 0.05 was considered statistically. Results: There was a significant discrepancy between the side of the surgery and the contralateral side in the two groups at 15 minutes, but the incidence of unilateral subarachnoid block anesthesia was more with the hyperbaric solution. Sensory and motor blockades were recorded in 18 patients (29.5%) in group I and in 48 patients (78.7%) in group II (P<0.05). Conclusions: Subarachnoid block anesthesia with hyperbaric bupivacaine solution has significantly more incidence of unilateral subarachnoid block anesthesia than isobaric bupivacaine solution after 15 minutes.

Keywords: Bupivacaine; unilateral subarachnoid block anesthesia; lower limb orthopedic surgery; blockade: sensory, motor.