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EP025 Local anesthetic bupivacaine baricity and adjuvant fentanyl impact on quality of low-dose spinal anesthesia
  1. Saule Svediene and
  2. Ieva Bartuseviciene
  1. Clinic of Anesthesiology and Intensive Care, Vilnius University, Vilnius, Lithuania


Background and Aims To evaluate the influence of bupivacaine baricity and fentanyl on quality of low-dose spinal anesthesia in knee arthroscopy.

Methods The research included patients (BMI>25), who underwent short-term knee surgery under low-dose spinal anesthesia. 3 groups formed: 7 mg/165cm(±1mg/5cm) isobaric bupivacaine +10µg fentanyl intrathecally (IF group); HF – 7 mg/165cm(±1mg/5cm) hyperbaric bupivacaine +10µg fentanyl; H – 7 mg/165cm(±1mg/5cm) hyperbaric bupivacaine alone. Groups compared for sensory/motor blockade extension and duration, haemodynamics, complications, pain-satisfaction rates.

Results The highest superficial[Th7] and deep[Th8-12] sensory blockade levels of operated limb at 60th min recorded in IF and HF groups. Lower sensory blockades[Th9; L1] detected in H group, compared with HF (p=0.003). Shorter (p<0.0001) sensory blockade caused by isobaric bupivacaine (-137.5 min), compared to hyperbaric with fentanyl. Lasting sensory blockade (+80 min) recorded in HF vs H group (p<0.0001). The motor blockade in groups HF and H was deeper (Bromage3), but only Bromage2 in IF group with shorter duration (-122 min vs HF; -59.5 min vs H (p<0.0001)). On the opposite limb sensory blockade was higher in HF than in H group[Th9 vs L4] (p=0.006); in latter – without motor blockade. Pruritus manifested 30% with fentanyl use. One patient developed hypotension, single case of urinary retention and nausea observed (HF group).

Conclusions Isobaric bupivacaine with fentanyl in low-dose spinal anesthesia ensured shorter duration of sensory/motor blockade, but sufficient analgesia – therefore had advantages over hyperbaric bupivacaine. Co-administration of fentanyl to hyperbaric bupivacaine associated with prolonged action, effects on unoperated limb, and we would not recommend for outpatient knee arthroscopy.

  • Isobaric/hyperbaric bupivacaine
  • low dose spinal anesthesia
  • adjuvant fentanyl
  • knee arthroscopy

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