Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anesthesia for ambulatory knee arthroscopy

Background:  We tested the hypothesis that selective spinal anesthesia for ambulatory knee arthroscopy can be accomplished with a small dose of bupivacaine at the L3/4 interspace with or without a head‐down tilt of 5° when the patients were in the lateral decubitus position. Methods:  In this double...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2005-01, Vol.49 (1), p.72-77
Main Authors: Korhonen, A-M., Valanne, J. V., Jokela, R. M., Ravaska, P., Volmanen, P., Korttila, K.
Format: Article
Language:English
Subjects:
Adult
Ambulatory
Anesthesia
Anesthesia, Spinal
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Local - administration & dosage
Arthroscopy
Biological and medical sciences
Body Mass Index
bupivacaine
Bupivacaine - administration & dosage
Double-Blind Method
Female
Head-Down Tilt
Humans
Knee - surgery
knee arthroscopy
Male
Medical sciences
Middle Aged
Monitoring, Intraoperative
Motor Neurons - drug effects
Nerve Block
Physical Stimulation
Prospective Studies
selective spinal anesthesia
vertebral column
vertebral interspace
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Summary:Background:  We tested the hypothesis that selective spinal anesthesia for ambulatory knee arthroscopy can be accomplished with a small dose of bupivacaine at the L3/4 interspace with or without a head‐down tilt of 5° when the patients were in the lateral decubitus position. Methods:  In this double‐blind study, 123 patients were randomly allocated to receive spinal anesthesia with 4 mg of hyperbaric bupivacaine inserted at either the L2/3 interspace, while the vertebral column was kept horizontal (L2/3 group), or the L3/4 level, with the vertebral column horizontal (L3/4H) or tilted 5° head‐down (L3/4T). At 7 min, an additional head down tilt was used in all groups if the sensory block was inadequate. Results:  In the L3/4T group the sensory block (Th8) reached a significantly higher level 30 min after spinal injection, compared with both the L2/3 (Th10) and L3/4H (Th11) groups. In the L3/4H group, 39% of the patients needed an additional tilt for 3 min at 7 min, compared with 10% (P=0.004) in the L3/4T group. Sacral block developed later and recovered faster (P
ISSN:0001-5172
1399-6576
DOI:10.1111/j.1399-6576.2004.00533.x