Unilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine-clonidine combination.
BACKGROUND
Low-dose hyperbaric bupivacaine has been used to produce unilateral spinal anaesthesia for outpatient surgery. Unilateral spinal anaesthesia is associated with reduction of hypotension, faster recovery and increased patient satisfaction. Small doses of clonidine have shown effectiveness in intensifying spinal anaesthesia. We investigated the effect of adding 15 microg of clonidine to 5 mg hyperbaric bupivacaine on unilaterality.


METHODS
Sixty patients undergoing outpatient knee arthroscopy were randomly allocated to receive either 1.2 ml (6 mg) of hyperbaric bupivacaine or a 1.2 ml solution containing 1.0 ml (5 mg) hyperbaric bupivacaine, 0.1 ml (75 microg) clonidine and 0.1 ml sterile water. The motor block was assessed by a modified Bromage scale and the sensory block by a pinprick.


RESULTS
There was a significant difference in the spread of anaesthesia between the operated and contralateral sides in both groups. Seventy-seven per cent of the blocks were unilateral in group B and 73% in group B-C. There was no significant difference between the groups, in unilaterality. The motor block was prolonged in group B-C but it did not affect home-readiness. Patients receiving clonidine needed more vasopressors. There was a significant difference in blood pressures between the groups, being lower in group B-C after 1 h 45 min.


CONCLUSIONS
Using 5 mg hyperbaric bupivacaine with 15 microg of clonidine, the unilaterality can be achieved and spinal anaesthesia intensified without affecting home-readiness. More vasopressors are needed in the beginning, but after the surgery patients experienced less pain.
Merivirta
R
R
Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, Surgical Hospital, Turku, Finland. riika.merivirta@tyks.fi
Kuusniemi
K
K
Jaakkola
P
P
Pihlajamäki
K
K
Pitkänen
M
M
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000556:Ambulatory Surgical Procedures; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001182:Arthroscopy; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D003000:Clonidine / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D007839:Functional Laterality / Q000187:drug effects; D006801:Humans; D007717:Knee / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D014662:Vasoconstrictor Agents / Q000494:pharmacology
D000316:Adrenergic alpha-Agonists; D000779:Anesthetics, Local; D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D003000:Clonidine; D002045:Bupivacaine