Unilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine-clonidine combination

• Published in: Acta anaesthesiologica Scandinavica Vol. 53; no. 6; pp. 788 - 793
• Main Authors: MERIVIRTA, R., KUUSNIEMI, K., JAAKKOLA, P., PIHLAJAMÄKI, K., PITKÄNEN, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2009; Blackwell
• Subjects: Adrenergic alpha-Agonists - administration & dosage; Adrenergic alpha-Agonists - adverse effects; Adult; Ambulatory Surgical Procedures; Anesthesia; Anesthesia, Spinal - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Arthroscopy; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Clonidine - administration & dosage; Clonidine - adverse effects; Drug Combinations; Female; Functional Laterality - drug effects; Humans; Knee - surgery; Male; Medical sciences; Middle Aged; Pain Measurement; Vasoconstrictor Agents - pharmacology; α2-Adrenergic receptor; Imidazole derivatives; Agonist; Imidazoline receptor; Local anesthetic; Bupivacaine; Surgery; Carboxamide; Anesthesia; Antihypertensive agent; Organic amide; α-Adrenergic receptor agonist; Clonidine; Ambulatory; Anilide; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2009.01955.x

Backround: Low‐dose hyperbaric bupivacaine has been used to produce unilateral spinal anaesthesia for outpatient surgery. Unilateral spinal anaesthesia is associated with reduction of hypotension, faster recovery and increased patient satisfaction. Small doses of clonidine have shown effectiveness in intensifying spinal anaesthesia. We investigated the effect of adding 15 μg of clonidine to 5 mg hyperbaric bupivacaine on unilaterality.
Methods: Sixty patients undergoing outpatient knee arthroscopy were randomly allocated to receive either 1.2 ml (6 mg) of hyperbaric bupivacaine or a 1.2 ml solution containing 1.0 ml (5 mg) hyperbaric bupivacaine, 0.1 ml (75 μg) clonidine and 0.1 ml sterile water. The motor block was assessed by a modified Bromage scale and the sensory block by a pinprick.
Results: There was a significant difference in the spread of anaesthesia between the operated and contralateral sides in both groups. Seventy‐seven per cent of the blocks were unilateral in group B and 73% in group B‐C. There was no significant difference between the groups, in unilaterality. The motor block was prolonged in group B‐C but it did not affect home‐readiness. Patients receiving clonidine needed more vasopressors. There was a significant difference in blood pressures between the groups, being lower in group B‐C after 1 h 45 min.
Conclusion: Using 5 mg hyperbaric bupivacaine with 15 μg of clonidine, the unilaterality can be achieved and spinal anaesthesia intensified without affecting home‐readiness. More vasopressors are needed in the beginning, but after the surgery patients experienced less pain.