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REGIONAL ANESTHESIA AND PAIN MEDICINE

The Comparison of Hypertonic Saline (7.5%) and Normal Saline (0.9%) for Initial Fluid Administration Before Spinal Anesthesia

Kati Järvelä, MD^*, Seppo E. Honkonen, MD, PhD, Timo Järvelä, MD, Tiit Kööbi, MD, PhD, and Seppo Kaukinen, MD, PhD^*

Departments of *Anaesthesia and Intensive Care, Orthopaedics, and Clinical Physiology, Tampere University Hospital, Tampere, Finland

Address correspondence and reprint requests to Kati Järvelä, MD, Department of Anaesthesia and Intensive Care, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere, Finland.

Hypertonic saline can be used for initial fluid administration before spinal anesthesia. It is effective in small-volume fluid resuscitation. This randomized double-blinded study compared the effects of 7.5% hypertonic saline (HS) and 0.9% normal saline (NS) in doses containing 2 mmol/kg of sodium in 40 ASA physical status I–II patients undergoing arthroscopy or other lower limb surgery under spinal anesthesia. We infused 1.6 mL/kg of HS or 13 mL/kg of NS for initial fluid administration before spinal anesthesia induced with a 10-mg dose of 0.5% hyperbaric bupivacaine. Etilefrine was administered to maintain mean arterial pressure at 80% of its control value. Systolic and diastolic blood pressure, heart rate, and cardiac index did not differ between the groups, and the amount of etilefrine administered was similar in the treatment groups. In all our patients, the plasma sodium concentrations were within the normal range after surgery and serum osmolality was within the normal range after spinal anesthesia. The time and the volume of the first micturition were similar in both groups, despite the much smaller amount of infused free water in the HS group. We conclude that 7.5% HS was as good as NS for the initial fluid administration before spinal anesthesia when the amount of sodium was kept unchanged.

Implications: Initial fluid administration with isotonic fluids is often used for the prevention of hypotension before spinal anesthesia. We infused 1.6 mL/kg of hypertonic saline 7.5% or 13 mL/kg of normal saline for the initial fluid administration and found that, by using hypertonic saline solution, effective initial fluid administration can be achieved without excess free water administration.

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