ABSTRACT
Purpose:
This study was designed to compare the anesthetic behavior, and hemodynamic consequences in spinal anesthesia performed with isobaric bupivacaine 0.5% 10 mg in the prone or jackknife position with those of spinal anesthesia performed with hyperbaric bupivacaine 0.5% 10 mg in the sitting/moved prone position in patients undergoing anorectal surgery.
Methods:
Sixty patients were allocated into three groups to receive spinal anesthesia in the sitting (Group I), prone (Group II), or jackknife (Group III) position. The subarachnoid puncture was performed using a standard midline approach with a 25-gauge pencilpoint spinal needle at L4-5 and hyperbaric or isobaric 0.5% bupivacaine 10 mg was injected according to the position.
Results:
Onset of anesthesia was significantly faster in Group I, with the highest level at L1 and median L2 in 10 min. The highest anesthesia level was at L1 in the other groups as well. The final median anesthesia level was L3 and L2 in Groups II and III, respectively, in 15 min. This segmental analgesia remained stable until 90, 105 and 75 min in Groups I, II and III, respectively. Two segment regression times were 106.40±9, 109.65±6 and 107.95±7 min in Groups I, II and III, respectively. Motor block reached 3 in all groups and returned to 2 within 105 min in Groups II and III and within 120 min in Group I.
Conclusion:
Spinal anesthesia can be performed successfully in the three different positions. Isobaric or hyperbaric bupivacaine 0.5% 10 mg produced similar anesthesia at L2 or L3 levels, which were suitable for pilonidal cyst excision in the prone position. However, isobaric bupivacaine 0.5% 10 mg was not favorable for ambulatory anorectal surgery in the jackknife position because of higher segmental anesthesia than predicted and longlasting motor blockade