Comparison of the effect of low and high doses of hyperbaric bupivacaine during spinal anesthesia in the lateral position during traumatological and orthopedic operations

Abstract

Annotation. The advantages and disadvantages of spinal anesthesia in the lateral position remain a debatable issue during the century of use of this method. The purpose of this work is to determine the effectiveness of the dosing of hyperbaric bupivacaine solution during spinal anesthesia with small and high doses of anesthetic in the lateral position depending on the height of the patient during operations on the lower extremities, as well as the study of cardiovascular complications and laboratory indicators of stress markers. 52 patients of I-II degrees of surgical risk according to ASA, divided into two groups, were examined. The first group (control) – 27 patients who underwent unilateral spinal anesthesia on the side with low doses of anesthetic (hyperbaric solution of 0.5% bupivacaine); the second group - 25 patients who underwent bilateral spinal anesthesia on the side with large doses of the same anesthetic during operations on the lower extremities. When assessing the effectiveness of the performed spinal anesthesia, the duration of sensory and motor blocks and the level of development of sensory blockade by dermatomes in both study groups were determined. To determine cardiovascular complications, mean blood pressure (MBP) and heart rate (HR) were measured before surgery, after 5 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, 5 hours, 7 hours, 9 hours. Also, blood glucose, lactate, and cortisol levels were determined in patients before surgery, for 3 hours, 6 hours. and 9 a.m. during the course of anesthesia. Statistical analysis was performed using Microsoft Excel and Statistica 12.5. In the 1st group, the sensory block was 189.3±34.3 min., the motor block was 154.1±28.6 min. In the II group, the sensory block was 384.4±61.4 min., the motor block was 321.0±50.49 min. During the study, it was found that the decrease in MBP and heart rate was predominant in the II group of the study. The volume of crystalloid infusion in the I study group was 1667±635 ml, and in the II group - 1784±621 ml. It was found that the duration of motor and sensory blockade in the lateral position was significantly higher by 51% in the group with high doses of hyperbaric bupivacaine. Selection of the dose of hyperbaric bupivacaine depending on the height of the patient and administration of high doses of the drug in the lateral position leads to more frequent manifestations of arterial hypotension and bradycardia, while the frequency of use of sympathomimetics did not increase, but the required volume of infusion therapy and the dose of atropine increased. The use of high doses of hyperbaric local anesthetic for spinal anesthesia in the lateral position led to an increase in stress markers for 6 hours. after the start of anesthesia.