Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 µg for outpatient knee arthroscopy with tourniquet
Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 µg of fe...
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Published in | Acta anaesthesiologica Scandinavica Vol. 47; no. 3; pp. 342 - 346 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford, UK
Munksgaard International Publishers
01.03.2003
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Abstract | Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 µg of fentanyl permits fast‐tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine.
Methods: In this double‐blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 µg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2‐min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast‐tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs.
Results: One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 (P = 0.002). The PACU‐time was shorter: 36 (10–103) vs. 55 (10–140) min, respectively (P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus.
Conclusion: Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU‐time was shorter in the bupivacaine‐fentanyl group, but both groups reached home‐readiness equally. |
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AbstractList | Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 µg of fentanyl permits fast‐tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine.
Methods: In this double‐blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 µg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2‐min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast‐tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs.
Results: One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 (P = 0.002). The PACU‐time was shorter: 36 (10–103) vs. 55 (10–140) min, respectively (P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus.
Conclusion: Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU‐time was shorter in the bupivacaine‐fentanyl group, but both groups reached home‐readiness equally. Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid does not prolong motor recovery and thus should not delay discharge home. We hypothesized that 3 mg of hyperbaric bupivacaine with 10 µg of fentanyl permits fast‐tracking or shorter stay in post anesthesia care unit (PACU), and earlier discharge home, compared with 4 mg of hyperbaric bupivacaine. Methods: In this double‐blind study, 100 outpatients undergoing knee arthroscopy received randomly either 4 mg of bupivacaine (B4) or 3 mg of bupivacaine + 10 µg fentanyl (B3F) intrathecally. The volume of 0.8 ml was injected at the L2/3 interspace over a 2‐min period. A lateral decubitus position was maintained for 10 min. The sensory block was recorded by using thermal stimuli, and motor block was assessed according to a modified Bromage scale. Fast‐tracking criteria were complete recovery of motor block, sensory block Th12 or lower and stable vital signs. Results: One block (1%) failed. Motor recovery was faster in the B3F group: 60% of the patients recovered in 80 min or less compared with 28% in group B4 ( P = 0.002). The PACU‐time was shorter: 36 (10–103) vs. 55 (10–140) min, respectively ( P = 0.005). Seventeen (B3F) vs. nine patients (B4) could bypass PACU (NS). Time to discharge home was similar in both groups. In the B3F group, 75% of the patients developed pruritus. Conclusion: Both solutions produced reliable spinal anesthesia for outpatient knee arthroscopy. The PACU‐time was shorter in the bupivacaine‐fentanyl group, but both groups reached home‐readiness equally. |
Author | Jokela, R. M. Valanne, J. V. Ravaska, P. Korhonen, A-M. Korttila, K. |
Author_xml | – sequence: 1 givenname: A-M. surname: Korhonen fullname: Korhonen, A-M. organization: Department of Anesthesia, Lapland Central Hospital, Rovaniemi – sequence: 2 givenname: J. V. surname: Valanne fullname: Valanne, J. V. organization: Department of Anesthesia, Lapland Central Hospital, Rovaniemi – sequence: 3 givenname: R. M. surname: Jokela fullname: Jokela, R. M. organization: Department of Anesthesia and Intensive Care, University of Helsinki, Helsinki, Finland – sequence: 4 givenname: P. surname: Ravaska fullname: Ravaska, P. organization: Department of Anesthesia, Lapland Central Hospital, Rovaniemi – sequence: 5 givenname: K. surname: Korttila fullname: Korttila, K. organization: Department of Anesthesia and Intensive Care, University of Helsinki, Helsinki, Finland |
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Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5 % publication-title: Acta Anesthesiol Scand – volume: 42 start-page: 767 year: 1998 end-page: 9 article-title: Transient radicular irritation after spinal anesthesia induced with hyperbaric solutions of cerebrospinal fluid‐diluted lidocaine 50mg/ml or mepivacaine 40mg/ml or bupivacaine 5 mg/ml publication-title: Acta Anaesthesiol Scand – volume: 84 start-page: 337 year: 1997 end-page: 41 article-title: The direction of the Whitacre needle aperture affect the extent and duration of isobaric spinal anesthesia publication-title: Anesth Analg – volume: 93 start-page: 1377 year: 2001 end-page: 9 article-title: Selective spinal anesthesia: a comparison of hyperbaric bupivacaine 4 mg versus 6 mg for outpatient knee arthroscopy publication-title: Anesth Analg – volume: 92 start-page: 1319 year: 2000 end-page: 23 article-title: Extent of hyperbaric spinal anesthesia influences the duration of spinal block publication-title: Anesthesiology – volume: 93 start-page: 319 year: 2001 end-page: 25 article-title: A comparison of minidose lidocaine‐fentanyl spinal anesthesia and local anesthesia/Propofol infusion for outpatient knee arthroscopy publication-title: Anesth Analg – volume: 79 start-page: 301 year: 1997 end-page: 5 article-title: Transient neurological symptoms after spinal anaesthesia with 4% mepivacaine and 0.5 % bupivacaine publication-title: Br J Anaesth – volume: 22 start-page: 534 year: 1997 end-page: 8 article-title: A low‐dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies publication-title: Regional Anesthesia – volume: 83 start-page: 716 year: 1996 end-page: 20 article-title: Spinal bupivacaine in ambulatory surgery: the effect of saline dilution publication-title: Anesth Analg – volume: 44 start-page: 436 year: 2000 end-page: 40 article-title: A randomised study of lidocaine and prilocaine for spinal anaesthesia publication-title: Acta Anaesthesiol Scand – volume: 50 start-page: 22 issue: Suppl. year: 1995 end-page: 8 article-title: Recovery from outpatient anaesthesia: factors affecting outcome publication-title: Anaesthesia – volume: 80 start-page: 730 year: 1995 end-page: 4 article-title: Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery publication-title: Anesth Analg – volume: 85 start-page: 560 year: 1997 end-page: 5 article-title: Intrathecal fentanyl with small‐dose dilute bupivacaine: better anesthesia without prolonging recovery publication-title: Anesth Analg – volume: 11 start-page: 511 year: 1998 end-page: 5 article-title: Unilateral spinal anaesthesia: gadget or tool? publication-title: Curr Opin Anaesthesiol – ident: e_1_2_5_13_2 doi: 10.1213/00000539-199610000-00009 – ident: e_1_2_5_11_2 doi: 10.1097/00115550-199924030-00015 – ident: e_1_2_5_16_2 doi: 10.1097/00000539-199702000-00017 – ident: e_1_2_5_2_2 doi: 10.1111/j.1365-2044.1995.tb06186.x – ident: e_1_2_5_17_2 doi: 10.1097/00000539-200010000-00018 – ident: e_1_2_5_6_2 doi: 10.1034/j.1399-6576.2000.440413.x – ident: e_1_2_5_7_2 doi: 10.1111/j.1399-6576.1998.tb05319.x – ident: e_1_2_5_5_2 doi: 10.1034/j.1399-6576.2000.440311.x – ident: e_1_2_5_19_2 doi: 10.1097/00000539-200108000-00016 – ident: e_1_2_5_8_2 doi: 10.1093/bja/79.3.301 – volume: 22 start-page: 534 year: 1997 ident: e_1_2_5_3_2 article-title: A low‐dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies publication-title: Regional Anesthesia contributor: fullname: Kuusniemi KS – ident: e_1_2_5_10_2 doi: 10.1097/00000542-200105000-00030 – ident: e_1_2_5_4_2 doi: 10.1097/00000539-200112000-00005 – ident: e_1_2_5_9_2 doi: 10.1213/00000539-199709000-00014 – ident: e_1_2_5_12_2 doi: 10.1007/BF03016692 – ident: e_1_2_5_15_2 doi: 10.1097/00000542-200005000-00020 – ident: e_1_2_5_20_2 doi: 10.1097/00000539-200010000-00017 – ident: e_1_2_5_14_2 doi: 10.1097/00001503-199810000-00011 – ident: e_1_2_5_18_2 doi: 10.1097/00000539-199504000-00014 |
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Snippet | Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid... Background: Combination of local anesthetic and opioid enables the use of less spinal anesthetic and increases the success of anesthesia. Intrathecal opioid... |
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SubjectTerms | Discharge after spinal anesthesia low-dose hyberbaric bupivacaine motor and sensory block outpatient PACU time spinal anesthesia unilateral |
Title | Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 µg for outpatient knee arthroscopy with tourniquet |
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