title: A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia.
abstract: OBJECTIVE
  The injection of small doses of local anesthetic solutions through pencil-point directional needles and maintaining the lateral decubitus position for 15 to 30 minutes after the injection have been suggested to facilitate the unilateral distribution of spinal anesthesia. We evaluated the effects of hypobaric and hyperbaric bupivacaine in attempting to achieve unilateral spinal anesthesia for patients undergoing lower limb orthopedic surgery.
  
  
  METHODS
  Fifty patients were randomly allocated into 2 groups to receive either 1.5 mL hyperbaric bupivacaine 0.5% (7.5 mg; n = 25) or 4.2 mL hypobaric bupivacaine 0.18% (7.5 mg; n = 25). Drugs were administered at the L3-4 interspace with the patient in the lateral position. Patients remained in this position for 15 minutes before turning supine for the operation. Spinal block was assessed by pinprick and modified Bromage scale on both sides.
  
  
  RESULTS
  Unilateral spinal block was observed in 20 patients in the hyperbaric group (80%) and in 19 patients in the hypobaric group (76%) while in the lateral position. However, 15 minutes after patients were turned supine, unilateral spinal anesthesia decreased to 68% of cases in the hyperbaric group and 24% of cases in the hypobaric group (P <.05). The motor block was more intense during the first 5 and 10 minutes (P <.05), but at the end of operation there was no difference between the groups. The hemodynamic changes were similar between the groups.
  
  
  CONCLUSIONS
  As a result, unilateral spinal anesthesia with hyperbaric and hypobaric bupivacaine provided a rapid motor and sensory recovery and good hemodynamic stability, but more unilateral spinal block was achieved in patients in the hyperbaric group when compared with patients in the hypobaric group.
authors.affiliation: Department of Anesthesiology, Ankara Oncology Hospital, Ankara, Turkey. mensurekaya@yahoo.com
authors.forename: Menşure
authors.initials: M
authors.lastname: Kaya
authors.forename: Selma
authors.initials: S
authors.lastname: Oğuz
authors.forename: Kemal
authors.initials: K
authors.lastname: Aslan
authors.forename: Nihal
authors.initials: N
authors.lastname: Kadioğullari
mesh_terms: D000328:Adult; D000399:Air Pressure; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D009407:Nerve Block; D019999:Pharmaceutical Solutions; D011446:Prospective Studies; D013346:Subarachnoid Space
chemical_list: D000779:Anesthetics, Local; D019999:Pharmaceutical Solutions; D002045:Bupivacaine