Abstract
Purpose
A prospective, randomized, double-blind clinical trial was undertaken to determine whether a tenfold difference in the rate of intrathecal injection of bupivacaine would affect sensory block level in parturients. Secondary outcomes included onset of block and the incidence of hypotension and nausea.
Methods
Following Research Ethics Board approval, 90 ASA I and II term parturients scheduled for Cesarean delivery were randomized to receive either fast injection (over four seconds, Group F) or slow injection (over 40 sec, Group S) of 0.75% hyperbaric bupivacaine 12 mg plus morphine 200 µg. Sensory block, motor block, and blood pressure were assessed every minute for the first 15 min, then every five minutes for the next 20 min. All occurrences of nausea, hypotension (decrease in systolic blood pressure > 30%) and ephedrine requirements were recorded.
Results
Forty-three patients in Group F and 42 patients in Group S completed the study. No differences in maximum sensory block height (Group F = median T2, interquartile range [T2-T4], Group S = T3 [T2-T4], P = 0.077) or time to achieve block height (F = 9.3 ± 4.3 min, S = 9.7 ± 4.7, P = 0.64) were observed. The frequencies of hypotension (Group F = 35/43, Group S = 32/42, P = 0.56), ephedrine utilization (Group F = 32/43, Group S = 26/42, P = 0.21) and nausea (Group F = 15/43, Group S = 16/42, P = 0.76) were similar.
Conclusion
Rapid intrathecal injection of hyperbaric bupivacaine does not affect spread of spinal anesthesia or the incidence of hypotension and nausea in parturients.
Résumé
Objectif
Une étude clinique prospective, randomisée et à double insu a été effectuée afin de déterminer si une vitesse d’injection de bupivacaïne intrathécale multipliée par dix modifie le niveau de bloc sensitif chez les parturientes. Le début du bloc ainsi que l’incidence d’hypotension et de nausée ont été enregistrés comme résultats secondaires.
Méthode
Suite à l’accord du Comité d’éthique en recherche, 90 parturientes ASA I et II à terme devant subir une césarienne ont été randomisées en deux groupes. Le premier a reçu une injection rapide (en quatre secondes, groupe F), et le second une injection lente (en 40 sec, groupe S) de 12 mg de bupivacaïne hyperbare à 0,75 % plus 200 µg de morphine. Les blocs sensitif et moteur ainsi que la tension artérielle ont été évalués chaque minute durant les 15 premières minutes, puis toutes les cinq minutes durant les 20 min suivantes. Les cas de nausées, d’hypotension (diminution de la tension artérielle systolique > 30 %) et le recours à l’éphédrine ont tous été enregistrés.
Résultats
Des données complètes ont été recueillies chez 43 patientes du groupe F et 42 du groupe S. Aucune différence n’a été observée dans la hauteur maximale du bloc sensitif (groupe F = moyenne T2, écart interquartile [T2-T4], groupe S = T3 [T2-T4], P = 0,077) ou dans le temps jusqu’à l’obtention de la hauteur du bloc (F = 9,3 ± 4,3 min, S = 9,7 ± 4,7, P = 0,64). La fréquence d’hypotension (groupe F = 35/43, groupe S = 32/42, P = 0,56), le recours à l’éphédrine (groupe F = 32/43, groupe S = 26/42, P = 0,21) et l’incidence de nausée (groupe F = 15/43, groupe S = 16/42, P = 0, 76) ont été similaires dans les deux groupes.
Conclusion
L’injection intrathécale rapide de bupivacaïne hyperbare n’affecte pas la progression de la rachianesthésie ou l’incidence d’hypotension et de nausée chez les parturientes.
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References
Fassoulaki A, Gatzou V, Pteropoulos G, Siafaka I. Spread of subarachnoid block, intraoperative local anesthetic requirements and postoperative analgesic requirements in caesarean section and total abdominal hysterectomy. Br J Anaesth 2004; 93: 678–82.
Hirabayashi Y, Shimizu R, Saitoh K, Fukuda H. Spread of subarachnoid hyperbaric amethocaine in pregnant women. Br J Anaesth 1995; 74: 384–6.
Bernards CM. Epidural and spinal anesthesia. In: Barash PG, Cullen BF, Stoelting RK (Eds).Clinical Anesthesia, 5th ed. Lippincott Williams & Wilkins; 2006: 701.
Bandi E, Weeks S, Carli F. Spinal block levels and cardiovascular changes during post-cesarean transport. Can J Anesth 1999; 46: 736–40.
Horlocker TT, Wedel DJ, Wilson PR. Effect of injection rate on sensory level and duration of hypobaric bupivacaine spinal anesthesia for total hip arthroplasty. Anesth Analg 1994; 79: 773–7.
Chin KW, Chin NM, Chin MK. Spread of spinal anaesthesia with 0.5% bupivacaine: influence of the vertebral interspace and speed of injection. Med J Malaysia 1994; 49: 142–8.
Atchison SR, Wedel DJ, Wilson PR. Effect of injection rate on level and duration of hypobaric spinal anesthesia. Anesth Analg 1989; 69: 496–500.
McClure JH, Brown DT, Wildsmith JA. Effect of injected volume and speed of injection on the spread of spinal anaesthesia with isobaric amethocaine. Br J Anaesth 1982; 54: 917–20.
Hanazaki M, Hashimoto M, Nogami S, Kusodo K, Aono H, Takeda A. Effect of injection speed on sensory blockade in spinal anesthesia with 0.5% hyperbaric tetracaine (Japanese). Masui 1997; 46: 777–82.
Tuominen M, Pitkanen M, Rosenberg PH. Effect of speed of injection of 0.5% plain bupivacaine on the spread of spinal anaesthesia. Br J Anaesth 1992; 69: 148–9.
Shih HY, Soga T, Sakai H, Okumura F, Lin SY. Infusion speed as a factor to influence the analgesic level of spinal anesthesia-hypobaric solution of tetracaine (Chinese). Ma Zui Xue Za Zhi 1990; 28: 171–5.
Stienstra R, Van Poorten F. Speed of injection does not affect the subarachnoid distribution of plain bupivacaine 0.5%. Reg Anesth 1990; 15: 208–10.
Janik R, Dick W, Stanton-Hicks M. The effect of the injection speed on the blockade characteristics of hyperbaric bupivacaine and tetracaine in spinal anesthesia (German). Reg Anaesth 1989; 12: 63–8.
Nasuhara H, Ohmi S, Yokoyama K. Influence of injection speed on the spread of 4 ml of 0.5% isobaric bupivacaine in spinal anesthesia (Japanese). Masui 2000; 49: 1363–6.
Casati A, Fanelli G, Cappelleri G, et al. Effects of speed of intrathecal injection on unilateral spinal block by 1% hyperbaric bupivacaine. A randomized, double-blind study. Minerva Anestesiol 1999; 65: 5–10.
Casati A, Fanelli G, Cappelleri G, Leoni A, Berti M, Aldegheri G. Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine? Br J Anaesth 1998; 81: 355–7.
Bucx MJ, Kroon JW, Stienstra R. Effect of speed of injection on the maximum sensory level for spinal anesthesia using plain bupivacaine 0.5% at room temperature. Reg Anesth 1993; 18: 103–5.
Van Gessel EF, Praplan J, Fuchs T, Forster A, Gamulin Z. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg 1993; 77: 483–7.
Bouchnak M, Belhadj N, Chaaoua T, Azaiez W, Hamdi M, Maghrebi H. Spinal anaesthesia for cesarean section: does injection speed have an effect on incidence of hypotension? (French). Ann Fr Anesth Reanim 2006; 25: 17–9.
Simon L, Boulay G, Ziane AF, et al. Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section. Int J Obstet Anesth 2000; 9: 10–4.
Anderson L, WalkerJ, Brydon C, Serpell MG. Rate of injection through Whitacre needles affects distribution of spinal anaesthesia. Br J Anaesth 2001; 86: 245–8.
Jawan B, Lee JH, Chong ZK, Chang CS. Spread of spinal anaesthesia for caesarean section in singleton and twin pregnancies. Br J Anaesth 1993; 70: 639–41.
Butterworth JF 4,th,Walker FO,Lysak SZ. Pregnancy increases median nerve susceptibility to lidocaine. Anesthesiology 1990; 72: 962–5.
Povey HM, Olsen PA, Pihl H. Spinal analgesia with hyperbaric 0.5% bupivacaine: effects of different patient positions. Acta Anaesthesiol Scand 1987; 31: 616–9.
Bourke DL, Sprung J, Harrison C, Thomas P. The dribble speed for spinal anesthesia. Reg Anesth 1993; 18: 326–7.
Holman SJ, Robinson RA, Beardsley D, Setwart S, Klein L, Stevens R. Hyperbaric dye solution distribution characteristics after pencil-point needle injection in a spinal cord model. Anesthesiology 1997; 86: 966–73.
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Funded in part by the Department of Anesthesia and Perioperative Medicine, St. Joseph’s Hospital, London.
An erratum to this article is available at http://dx.doi.org/10.1007/BF03022334.
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Singh, S.I., Morley-Forster, P.K., Shamsah, M. et al. Influence of injection rate of hyperbaric bupivacaine on spinal block in parturients: a randomized trial. Can J Anesth 54, 290–295 (2007). https://doi.org/10.1007/BF03022774
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DOI: https://doi.org/10.1007/BF03022774