Comparison of hyperbaric and plain articaine in spinal anaesthesia for open inguinal hernia repair

• Published in: British journal of anaesthesia : BJA Vol. 101; no. 6; pp. 848 - 854
• Main Authors: Bachmann, M., Pere, P., Kairaluoma, P., Rosenberg, P.H., Kallio, H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.12.2008; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; ambulatory; anaesthetic techniques; anaesthetic techniques, regional, spinal; anaesthetics local; anaesthetics local, articaine; Anesthesia; Anesthesia Recovery Period; Anesthesia, Spinal - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; articaine; Biological and medical sciences; Carticaine - administration & dosage; Double-Blind Method; Female; Hernia, Inguinal - surgery; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Movement - drug effects; regional; Sensation - drug effects; Specific Gravity; spinal; surgery; surgery, ambulatory; Young Adult; surgery, ambulatory; anaesthetic techniques, regional, spinal; anaesthetics local, articaine; regional; articaine; surgery; spinal; anaesthetics local; Local anesthetic; Ester; Abdominal disease; Surgery; Anesthesia; Organic amide; Articaine; Ambulatory; anaesthetic techniques; Inguinal hernia; Comparative study
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aen294

Fast onset and short duration are prominent properties of the amide-type local anaesthetic articaine. Similar to bupivacaine, a hyperbaric solution of articaine may produce faster onset and shorter duration of spinal anaesthesia than a plain solution. Patients undergoing open inguinal hernia repair received in random order articaine 84 mg in either hyperbaric (HyperA, n=49) or plain solution (PlainA, n=48) intrathecally. A blinded observer tested the dermatomal spread (pinprick) and motor block (Bromage scale). Median (range) onset time to the T10 dermatome was 2 (2–8) (n=46) and 6 (2–30) min (n=39) (P<0.001), and the duration of the sensory block at (or above) the T10 dermatome was 86 (39–148) and 69 (15–118) min (P=0.007), in Groups HyperA and PlainA, respectively. Peak sensory block was greater in Group HyperA T4 (L2–C2) than in Group PlainA T8–T7 (L3–T3) dermatome, median (range), P<0.001. Spread of the block to the cervical dermatomes associated with hypotension occurred in three patients of Group HyperA (one patient C2 and two C4). The sensory block resolved to the S2 dermatome significantly faster in Group HyperA, 2.5 (1.5–4.5) h, than in Group PlainA, 3.5 (2.0–4.5) h (P<0.001). Median duration of the motor block was significantly shorter in Group HyperA, 2.0 (1.3–3.5) vs 3.0 (1.5–4.0) h (P<0.001). Hyperbaric articaine 84 mg had a faster onset and shorter duration of spinal anaesthesia than the plain solution.