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REGIONAL ANESTHESIA

Isobaric Versus Hypobaric Spinal Bupivacaine for Total Hip Arthroplasty in the Lateral Position

Alexandre Faust, MD^*, Roxane Fournier, MD^*, Elisabeth Van Gessel, MD^*, Anne Weber, MD^*, Pierre Hoffmeyer, MD, and Zdravko Gamulin, MD^*

*Division of Anesthesiology, Clinic of Orthopedic Surgery, University Hospital Geneva, Geneva, Switzerland

Address correspondence and reprint requests to Dr. Alexandre Faust, Division d’ Anesthésiologie, Hôpital Cantonal—Hôpitaux Universitaires de Genève, Rue Micheli-du-Crest 24, 1211 Genève 14, Switzerland. Address e-mail to alexandre.faust{at}hcuge.ch

Total hip arthroplasty (THA) is frequently performed under spinal anesthesia using either isobaric or hypobaric anesthetic solution. However, these two solutions have never been compared under similar surgical conditions. In the present study, we compared the anesthetic and hemodynamic effects of isobaric and hypobaric bupivacaine in 40 ASA physical status I–II patients undergoing THA in the lateral decubitus position under spinal anesthesia. With operative side up, patients randomly received, in a double-blinded manner, a spinal injection of 3.5 mL (17.5 mg) of plain bupivacaine mixed with either 1.5 mL of normal saline (isobaric group) or 1.5 mL of distilled water (hypobaric group). Sensory level and degree of motor block were evaluated on the nondependent and dependent sides until regression to L2 and total motor recovery. Hemodynamic changes during the first 45 min after spinal injection, and the time between spinal administration and first analgesic for a pain score >3 (on a 0–10 scale) were noted. Demographic characteristics of both groups were comparable. Upper sensory level and maximal degree of motor block were comparable between the operative and nonoperative sides in each group and between corresponding sides in both groups. Compared with the isobaric group, in the hypobaric group there was a prolonged time to sensory regression to L2 on the operative side (287 ± 51 versus 242 ± 36 min, P < 0.004) and a prolonged time to first analgesic (290 ± 46 versus 237 ± 39 min, P < 0.001). No difference in quality of motor block was noted at the end of surgery. Hemodynamic changes were comparable. We conclude that for THA in the lateral position, spinal hypobaric bupivacaine seems to be superior to isobaric in that it prolongs the sensory block on the operative side and delays the use of analgesics after surgery without further compromising hemodynamic stability.

IMPLICATIONS: For total hip arthroplasty in the lateral position, spinal hypobaric bupivacaine compared with isobaric prolonged sensory block at the operative side and delayed the time to first analgesic.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999