title: Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study.
abstract: OBJECTIVE
  To produce selective spinal anesthesia for adult anorectal surgery.
  
  
  METHODS
  Double-blinded, randomized, controlled trial.
  
  
  METHODS
  Operating room and postoperative recovery area.
  
  
  METHODS
  152 adult, consecutive ASA physical status I, II, and III patients.
  
  
  METHODS
  After patients underwent dural puncture in the sitting position at L3-L4 or L4-L5, 0.5% hyperbaric bupivacaine was injected over two minutes: Group S7.5 received 1.5 mL, Group S5 received 1.0 mL, and Group S4 0.8 mL. After sitting for 10 minutes, patients were positioned for surgery.
  
  
  METHODS
  Rate of success, level and duration of sensory and motor block, time to voiding and ambulation, complications, and quality of anesthesia according to the patient and medical staff, were recorded.
  
  
  RESULTS
  Spinal block had a 98% rate of success. Mean level of sensory block was 10.4 +/- 1.7, 7.4 +/- 2.2, and 7.0 +/- 1.8 dermatomes in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, and S7.5 vs S4). Mean duration of sensory block was 310.5 +/- 42.6, 255.9 +/- 43.7, and 228.8 +/- 34.8 min in Groups S7.5, S5, and S4 (P < 0.01 S7.5 vs S5, S7.5 vs S4, and S5 vs S4). Motor block was Bromage score 2-3 in 70.5% of Group S7.5 patients versus Bromage score 0-1 in 97.3% of Group S5 and 92.1% of Group S4 patients (P < 0.05).
  
  
  CONCLUSIONS
  A dose of 4 mg of hyperbaric bupivacaine produces a similar level of sensory and motor block as a 5 mg dose but with shorter duration and faster recovery.
authors.affiliation: Department of Anesthesiology, Kaunas University of Medicine Hospital, Kaunas, LT 50009, Lithuania. jurate.gudaityte@kmuk.lt
authors.forename: Jurate
authors.initials: J
authors.lastname: Gudaityte
authors.forename: Irena
authors.initials: I
authors.lastname: Marchertiene
authors.forename: Aurika
authors.initials: A
authors.lastname: Karbonskiene
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Saladzinskas
authors.forename: Algimantas
authors.initials: A
authors.lastname: Tamelis
authors.forename: Igoris
authors.initials: I
authors.lastname: Toker
authors.forename: Dainius
authors.initials: D
authors.lastname: Pavalkis
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology; D011229:Preanesthetic Medication; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D018401:Sample Size
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine