title: Increase in specific density of levobupivacaine and fentanyl solution ensures lower incidence of inadequate block.
abstract: The clinical presentation of a subarachnoid block (SAB) is dependent upon the intrathecal spread of local anesthetic (LA). Intrathecal distribution depends on the chemical and physical characteristics of LA, puncture site, technique used, patient anatomical characteristics and hydrodynamic properties of cerebrospinal fluid. We tried to determine whether a combined glucose/LA solution can render a clinically significant difference in sensory block distribution and motor block intensity.This was a controlled, randomized and double blinded study. The surgical procedures were stripping of the great or small saphenous vein and extirpation of remaining varicose veins. The study included 110 patients distributed into two groups: Hyperbaric (7.5 mg levobupivacaine (1.5 ml 0.5% Chirocaine) + 50 microg Fentanyl (0.5 ml Fentanil) and 1 ml 10% glucose (Pliva)) vs. Hypobaric (7.5 mg levobupivacaine (1.5 ml 0.5% Chirocaine) + 50 microg Fentanyl (0.5 ml Fentanil) and 1 ml 0.9% NaCl (Pliva, Zagreb)) adding to a total volume of 3.5 ml per solution. Spinal puncture was at L3-L4 level. Spinal block distribution was assessed in five minute intervals and intensity of motor block was assessed according to the modified Bromage scale. Pain was assessed with the Visual Analogue Scale. A statistically significant difference in sensory block distribution, motor block intensity and recovery time was established between hyperbaric and hypobaric solutions. By increasing the specific density of anesthetic solution, a higher sensory block, with lesser variability, a diminished influence of Body Mass Index, decreased motor block intensity and faster recovery time may be achieved.
authors.affiliation: University of Zagreb, Dubrava University Hospital, Clinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia. ivanatd@yahoo.com
authors.forename: Ivana Tudorić
authors.initials: IT
authors.lastname: Djeno
authors.forename: Viktor
authors.initials: V
authors.lastname: Duzel
authors.forename: Marko
authors.initials: M
authors.lastname: Ajduk
authors.forename: Zrinka Safarić
authors.initials: ZS
authors.lastname: Oremus
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zupcić
authors.forename: Silva
authors.initials: S
authors.lastname: Dusper
authors.forename: Dubravko
authors.initials: D
authors.lastname: Jukić
authors.forename: Ino
authors.initials: I
authors.lastname: Husedzinović
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D000328:Adult; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D006801:Humans; D000077554:Levobupivacaine; D008875:Middle Aged; D010865:Pilot Projects; D012996:Solutions / Q000493:pharmacokinetics; D013346:Subarachnoid Space; D014648:Varicose Veins / Q000601:surgery*
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D012996:Solutions; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine