Original scientific paper
Increase in Specific Density of Levobupivacaine and Fentanyl Solution Ensures Lower Incidence of Inadequate Block
Ivana Tudorić Djeno
Viktor Đuzel
Marko Ajduk
Zrinka Šafarić Oremuš
Miroslav Župčić
Silva Dusper
Dubravko Jukić
Ino Husedžinović
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 mg Fentanyl (0.5 ml Fentanil®) and
1 ml 10% glucose (Pliva)) vs. Hypobaric (7.5 mg levobupivacaine (1.5 ml 0.5% Chirocaine®) + 50 mg 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.
Keywords
spinal anesthesia; hyperbaric block; levobupivacaine and fentanyl
Hrčak ID:
84772
URI
Publication date:
10.7.2012.
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