Intrathecal Injection of Hyperbaric Bupivacaine Versus a Mixture of Hyperbaric and Isobaric Bupivacaine in Patients Undergoing Lower Abdominal Surgery: A Randomized Controlled Trial
Overview
- Phase
- Not Applicable
- Intervention
- Group A (hyperbaric bupivacaine)
- Conditions
- Spinal Anesthesia
- Sponsor
- Helwan University
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- Incidence of hypotension
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The aim of this study is to compare the effects of intrathecal injection of hyperbaric bupivacaine versus injection of hyperbaric and isobaric bupivacaine in patients undergoing lower abdominal surgery.
Detailed Description
Spinal anesthesia is one of the most commonly used nerve block procedures for surgical operations involving the lower abdomen, the perineum, and the lower limbs, owing to its quick effect and cost-effectiveness. Spinal anesthesia is advantageous in that it uses a small dose of anesthesia, is simple to perform, and offers a rapid onset of action, reliable surgical analgesia, and good muscle relaxation. The Baricity of a solution is defined as the ratio of the density of the solution to that of the cerebrospinal fluid (CSF). The most common anesthetic used for SA in obstetric and non-obstetric surgery is bupivacaine, which can be formulated as an isobaric or hyperbaric solution. Baricity differences between spinal anesthetic solutions are thought to affect hemodynamic parameters and distribution within the subarachnoid space, which may, in turn, affect the onset, extent, and duration of sensory block as well as side effects. Spinal anesthesia has been linked to different adverse effects, out of which hypotension is most common complication. The incidence of hypotension is 25-75% in general population. Factors that increase the risk of hypotension include patient factors (advanced age, pregnancy, obesity, diabetes mellitus, hypertension, and anemia) and technical factors such as a block level at or above T5, use of opioids during premedication, and high local anesthetic dosages.
Investigators
Adel Ali Hassan
Lecturer of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Helwan University
Helwan University
Eligibility Criteria
Inclusion Criteria
- •Age between 18-65 years old.
- •Both sexes.
- •American Society of Anaesthesia (ASA) I to II.
- •Undergoing lower abdominal or urological surgery under spinal anesthesia
Exclusion Criteria
- •Allergy to amide.
- •Patients with a significant history of substance abuse.
- •Patients with diabetes mellitus, neurological or cardiovascular diseases.
- •Patients with neuromuscular diseases.
- •Pregnant patients.
Arms & Interventions
Group A (hyperbaric bupivacaine)
Patients were injected intrathecally with 20 mg hyperbaric bupivacaine 0.5% solution.
Intervention: Group A (hyperbaric bupivacaine)
Group B (Mixture of Hyperbaric and Isobaric Bupivacaine)
Patients received 10 mg hyperbaric bupivacaine and 10 mg isobaric bupivacaine 0,5 % solution.
Intervention: Group B (Mixture of Hyperbaric and Isobaric Bupivacaine)
Outcomes
Primary Outcomes
Incidence of hypotension
Time Frame: 3 hours post-injection
Blood pressure was recorded using standard non-invasive monitors at 5, 10, 15, 20, 25, 30, 45, and 60 min, then hourly until 3 h post-injection. Hypotension was defined as a decrease in mean arterial pressure of more than 30% from baseline.
Secondary Outcomes
- Heart rate(3 hours post-injection)
- Mean arterial pressure (MAP)(3 hours post-injection)