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The Effects of Two Different Doses of Spinal Hyperbaric Solution of Ropivacaine in Elderly Patients

Year 2007, Volume: 14 Issue: 1, 27 - 31, 01.02.2007

Abstract

Aim: Ropivacaine has been recently demonstrated useful for spinal anaesthesia in several studies. In this study, we were aimed to investigate the safety and efficacy of two different doses of intrathecal hyperbaric ropivacaine in elderly patients undergoing urological surgery. Materials and Methods: Fifty male patients (ASA I-III, aged ≥ 65 yr) scheduled for urological surgery were studied. Patients were randomly allocated to one of the two doses of spinal ropivacaine: 15 or 18 mg. Sensory changes were assessed by pinprick test and motor blockage was assessed by modified Bromage score. The haemodynamic variables and adverse events were recorded. Results: Although the duration of sensory block in group II was longer than group I (223.7 ± 88.1 min and 192.6 ± 61.2 min), the difference between the groups was not significant. Motor block was significantly longer in the group II than in the group I (141.7 ± 43.3 min vs 114.5 ± 25.9 min) (P<0.05). The time to regression of two dermatomes of the sensory block in the group I (67.8 ± 22.4 min) was shorter than in group II (79.2 ± 32.2 min), but the difference was not significant. The incidence of side effects was similar between groups. Conclusion: We thought that hyperbaric ropivacaine 15 or 18 mg for spinal anaesthesia may be more suitable in elderly patients, but a shorter sensory and motor blockade time of hyperbaric ropivacaine 15 mg was a major advantage. Key words: Spinal anaesthesia, Hyperbaric ropivacaine, Elderly patients

References

  • Veering BT, Burm AG, Vletter AA, van den Hoeven RA, Spierdijk J. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration. Anesthesiology 1991; 74: 250-7.
  • Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996; 51: 1139-43.
  • Martyr JW and Clark MX. Hypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions. Anaesth Intensive Care 2001; 29: 501-5.
  • Gautier PE, De Kock M, Van Steenberge A, Poth N, Lahaye-Goffart B, Fanard L, Hody JL. Intrathecal ropivacaine for ambulatory surgery: a comparison between intrathecal bupivacaine and intrathecal ropivacaine for knee arthroscopy. Anesthesiology 1999; 91: 1239-45.
  • Khaw KS, Ngan Kee WD, Wong EL, Liu JY, Chung R Spinal ropivacaine for cesarean section: a dose-finding study. Anesthesiology 2001; 95: 1346-50.
  • Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, Bouchot O, Pinaud M. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg 2000; 91: 1457-60.
  • Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg 2001; 93: 157-61.
  • Whiteside JB, Burke D, Wildsmith JAW. Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003; 90: 304-8.
  • Kallio H, Snall EVT, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth 2004; 93:664-9.
  • Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth 2005; 94: 107-11.
  • Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 1148-53
  • Whiteside JB, Burke D, Wildsmith JAW. Spinal anaesthesia with ropivacaine 5 mg ml- 1 in glucose 10 mg ml-1 or 50 mg ml-1. Br J Anaesth 2001; 86: 241-4.
  • Veering BT, Ter Riet PM, Burm AG, Stienstra R, van Kleef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia. Br J Anaesth 1996; 77: 343-6.
  • McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml-1 with bupivacaine 5 mg ml-1 for major orthopaedic surgery. Br J Anaesth 2002; 89: 702-6.
  • McNamee DA, Parks L, McClelland AM, Scott S, Milligan KR, Ahlen K, Gustafsson U. Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml-1 and 10 mg ml-1 solutions. Br J Anaesth 2001; 87: 743-7.
  • Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solution. Anesth Analg 2002; 94: 680-5.

Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi

Year 2007, Volume: 14 Issue: 1, 27 - 31, 01.02.2007

Abstract

Amaç: Son yıllarda yapılan çalışmalarda spinal anestezide ropivakain kullanımının yararları gösterilmiştir. Bu çalışmada, spinal anestezi altında ürolojik cerrahi girişim geçirecek yaşlı olgularda iki farklı dozda intratekal hiperbarik ropivakainin etkinlik ve güvenilirliğini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya, ürolojik cerrahi geçirecek, ASA I-III grubu, 65 yaş üstü 50 erkek olgu dahil edildi. Olgular, iki farklı intratekal hiperbarik ropivakain dozundan (Grup I, 15 veya Grup II, 18 mg) birini alacak şekilde rasgele iki gruba ayrıldı. Duyu bloğu pinprik testi, motor blok ise modifiye Bromage skoru ile değerlendirildi. Hemodinamik veriler ve yan etkiler kaydedildi. Bulgular: Duyu bloğu süresi grup II'de (223.7 ± 88.1 dk) grup I'e (192.6 ± 61.2 dk) göre daha uzundu, ancak istatistiksel olarak anlamlı değildi. Motor blok süresi grup II'de grup I'e göre anlamlı olarak daha uzundu (141.7 ± 43.3 ve 114.5 ± 25.9 dk) (p<0.05). Duyu bloğunun 2 dermatom gerileme zamanı gruplar arasında anlamlı olarak farklı değildi (67.8 ± 22.4 ve 79.2 ± 32.2 dk). Gelişen yan etkiler açısından gruplar birbirine benzerdi. Sonuç: Yaşlı olgularda spinal anestezi amacıyla hiperbarik ropivakainin 15 ve 18 mg'lık dozları kullanılabilir. Fakat 15 mg'lık hiperbarik ropivakainin daha kısa süreli duyusal ve motor blok oluşturması önemli bir avantajdır. Anahtar kelimeler: Spinal anestezi, Hiperbarik ropivakain, İleri yaş

References

  • Veering BT, Burm AG, Vletter AA, van den Hoeven RA, Spierdijk J. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration. Anesthesiology 1991; 74: 250-7.
  • Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia 1996; 51: 1139-43.
  • Martyr JW and Clark MX. Hypotension in elderly patients undergoing spinal anaesthesia for repair of fractured neck of femur. A comparison of two different spinal solutions. Anaesth Intensive Care 2001; 29: 501-5.
  • Gautier PE, De Kock M, Van Steenberge A, Poth N, Lahaye-Goffart B, Fanard L, Hody JL. Intrathecal ropivacaine for ambulatory surgery: a comparison between intrathecal bupivacaine and intrathecal ropivacaine for knee arthroscopy. Anesthesiology 1999; 91: 1239-45.
  • Khaw KS, Ngan Kee WD, Wong EL, Liu JY, Chung R Spinal ropivacaine for cesarean section: a dose-finding study. Anesthesiology 2001; 95: 1346-50.
  • Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, Bouchot O, Pinaud M. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg 2000; 91: 1457-60.
  • Chung CJ, Choi SR, Yeo KH, Park HS, Lee SI, Chin YJ. Hyperbaric spinal ropivacaine for cesarean delivery: a comparison to hyperbaric bupivacaine. Anesth Analg 2001; 93: 157-61.
  • Whiteside JB, Burke D, Wildsmith JAW. Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery. Br J Anaesth 2003; 90: 304-8.
  • Kallio H, Snall EVT, Tuomas CA, Rosenberg PH. Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery. Br J Anaesth 2004; 93:664-9.
  • Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA. Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia. Br J Anaesth 2005; 94: 107-11.
  • Hampl KF, Schneider MC, Ummenhofer W, Drewe J. Transient neurologic symptoms after spinal anesthesia. Anesth Analg 1995; 81: 1148-53
  • Whiteside JB, Burke D, Wildsmith JAW. Spinal anaesthesia with ropivacaine 5 mg ml- 1 in glucose 10 mg ml-1 or 50 mg ml-1. Br J Anaesth 2001; 86: 241-4.
  • Veering BT, Ter Riet PM, Burm AG, Stienstra R, van Kleef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia. Br J Anaesth 1996; 77: 343-6.
  • McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml-1 with bupivacaine 5 mg ml-1 for major orthopaedic surgery. Br J Anaesth 2002; 89: 702-6.
  • McNamee DA, Parks L, McClelland AM, Scott S, Milligan KR, Ahlen K, Gustafsson U. Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml-1 and 10 mg ml-1 solutions. Br J Anaesth 2001; 87: 743-7.
  • Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A. Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solution. Anesth Analg 2002; 94: 680-5.
There are 16 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Hüseyin İ. Toprak This is me

Özlem Sağır This is me

Semra Demirbilek This is me

Ahmet Köroğlu This is me

Kadir Demir This is me

M.özcan Ersoy This is me

Publication Date February 1, 2007
Published in Issue Year 2007 Volume: 14 Issue: 1

Cite

APA Toprak, H. İ., Sağır, Ö., Demirbilek, S., Köroğlu, A., et al. (2007). Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi. Journal of Turgut Ozal Medical Center, 14(1), 27-31.
AMA Toprak Hİ, Sağır Ö, Demirbilek S, Köroğlu A, Demir K, Ersoy M. Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi. J Turgut Ozal Med Cent. February 2007;14(1):27-31.
Chicago Toprak, Hüseyin İ., Özlem Sağır, Semra Demirbilek, Ahmet Köroğlu, Kadir Demir, and M.özcan Ersoy. “Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi”. Journal of Turgut Ozal Medical Center 14, no. 1 (February 2007): 27-31.
EndNote Toprak Hİ, Sağır Ö, Demirbilek S, Köroğlu A, Demir K, Ersoy M (February 1, 2007) Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi. Journal of Turgut Ozal Medical Center 14 1 27–31.
IEEE H. İ. Toprak, Ö. Sağır, S. Demirbilek, A. Köroğlu, K. Demir, and M. Ersoy, “Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi”, J Turgut Ozal Med Cent, vol. 14, no. 1, pp. 27–31, 2007.
ISNAD Toprak, Hüseyin İ. et al. “Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi”. Journal of Turgut Ozal Medical Center 14/1 (February 2007), 27-31.
JAMA Toprak Hİ, Sağır Ö, Demirbilek S, Köroğlu A, Demir K, Ersoy M. Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi. J Turgut Ozal Med Cent. 2007;14:27–31.
MLA Toprak, Hüseyin İ. et al. “Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi”. Journal of Turgut Ozal Medical Center, vol. 14, no. 1, 2007, pp. 27-31.
Vancouver Toprak Hİ, Sağır Ö, Demirbilek S, Köroğlu A, Demir K, Ersoy M. Yaşlı Olgularda Spinal Hiperbarik Ropivakainin İki Farklı Dozunun Etkisi. J Turgut Ozal Med Cent. 2007;14(1):27-31.