Published online Nov 27, 2013. doi: 10.5313/wja.v2.i3.18
Revised: May 30, 2013
Accepted: June 18, 2013
Published online: November 27, 2013
AIM: To compare the effect of hyperbaric levobupivacaine and bupivacaine on the quality of the block, patient satisfaction, and discharge time in patients undergoing arthroscopic knee surgery under unilateral spinal anesthesia.
METHODS: One hundred and thirty-two patients, American Society of Anaesthesiologists I or II, scheduled for elective ambulatory knee arthroscopy were randomly assigned to four double-blind groups. To achieve a unilateral spinal block, Group BF received 5 mg of hyperbaric bupivacaine plus 20 μg of fentanyl intrathecally, Group LF received 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl intrathecally, Group B received 5 mg of hyperbaric bupivacaine intrathecally, and Group L received 5 mg of hyperbaric levobupivacaine intrathecally. The level and duration of the sensory block, the intensity and duration of the motor block, the time to first analgesic requirement, and the time elapsed until the patient’s discharge were recorded. Hemodynamic values and adverse effects were also recorded.
RESULTS: The duration of time needed to reach the T12 dermatome level was significantly longer in Group L [7 (3-20) min] than in Group B [6 (3-12) min] (P = 0.006). The maximum sensory level reached on the side undergoing the operation was significantly higher in Group BF than in Group B (P < 0.05). The intensity of the motor blockade was greater in Group BF than in Group LF and L. Complete recovery from motor blockade occurred earlier in Groups LF [75 (45-165) min] and L [63 (35-120) min] than in Group BF [115 (60-180) min] (P < 0.05). The length of time needed for the sensory block to regress to the level of S2 was shorter in Group L (154 ± 50) than in Group BF (192 ± 66) (P < 0.05). The quality of the block was significantly lower in Group L than in Groups BF, LF and B (P = 0.012, P = 0.003, and P < 0.001, respectively). The time elapsed until Visual Analog Scale ≥ 4 was significantly shorter in Group L (110 ± 48) than in Groups BF (200 ± 60), LF (156 ± 61) and B (162 ± 52) (P < 0.05). The time elapsed until the patient’s discharge was shorter in Groups B (244 ± 54) and L (229 ± 55) than in Group BF (288 ± 64) (P = 0.021 and P = 0.001, respectively). There were no differences among the groups regarding hemodynamic parameters and adverse events, except for pruritus. The occurrence of pruritus was significantly more frequent in Groups BF and LF than in other groups.
CONCLUSION: In conclusion, 5 mg of hyperbaric bupivacaine and 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl provided a better spinal anesthesia than 5 mg of hyperbaric levobupivacaine alone.
Core tip: Arthroscopic knee surgery is a common procedure performed in the ambulatory setting. The primary goals of the anesthetic techniques used in ambulatory surgery are to reduce anesthetic complications and to allow for early patient discharge. The aim of this study was to compare the effect of low dose hyperbaric bupivacaine and levobupivacaine, with and without fentanyl, on the quality of the block, patient satisfaction, and the time elapsed until discharge in patients undergoing arthroscopic knee surgery under unilateral spinal anesthesia.