[Clinical research of hyperbaric, isobaric, and hypobaric solutions of bupivacaine in continuous spinal anesthesia].

OBJECTIVE

To compare the anesthesia properities of hyperbaric bupivacaine with those of isobaric and hypobaric solutions when administered in the supine position undergoing hip surgery or lower limb surgery using continuous spinal anesthesia.

METHODS

Sixty patients( ASA I approximately III ) scheduled for hip or lower limb surgery were randomly divided into 3 groups with 20 patients in each group: Group A: 0. 375% hyperbaric bupivacaine solutions; Group B :0.375% isobaric bupivacaine solutions; and Group C: 0. 375% hypobaric bupivacaine solutions. The following variables were measured every 2 minutes during the first 30 minutes after the intrathecal injection : the onset time of sensation block, the highest plane of analgesia, the time to reach complete motor blockade, and the plane of analgesia and the extent of lower extremities' movement (modified bromage score, BMS) at different time after the administration. Meanwhile the changes of hemodynamics were recorded.

RESULTS

There was no statistical difference among the basic conditions ( P > 0.05). The onset time of sensation block, and the time to reach complete motor blockade, and the time receiving the highest sharp pain sensory block in Group A were significantly shorter than those in Group B and Group C ( P < 0.01 ). The plane of analgesia obtained in the hyperbaric group was significantly higher than in both the isobaric and the hypobaric groups ( P < 0.01). The mean arterial pressure(MAP) , HR in the hyperbaric group decreased significantly after the intrathecal injection( P < 0.05 ).

CONCLUSION

The 0.375% Isobaric bupivacaine used during contiuous spinal anesthesia in the supine position produces a suitable and a more "controllable" anesthesia, but a minimum dosage of 10 approximately 12.5 mg is required to obtain adequate anesthesic conditions with moderate hemodynamic changes and satisfying analgesia effects. Under similar conditions, 0. 375% hyperbaric bupivacaine produces major hemodynamic consequences with high cephalad spread and 0. 375% hypobaric bupivacaine has a too long onset time.