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Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy

Guido Fanelli, MD^*, Battista Borghi, MD, Andrea Casati, MD^*, Laura Bertini, MD, Milena Montebugnoli, MD, Giorgio Torri, MD^* and On behalf of the Italian Study Group on Unilateral Spinal Anesthesia^,

^* From the University of Milan - Department of Anesthesiology IRCCS H. San Raffaele, Milan,
the Department of Anesthesiology, IRCCS Rizzoli Orthopedic Institute, Bologna,
the Department of Anesthesiology, CTO, Roma and
The Italian Study Group on Unilateral Spinal Anesthesia.

Address correspondence to: Dr. A. Casati, Department of Anesthesiology - IRCCS H San Raffaele, Via Olgettina 60, 20132 Milan, Italy. Phone: +39-02-26432656; Fax: +39-02-26412823; E-mail: casati.andrea{at}hsr.it

Purpose: To compare unilateral and conventional bilateral bupivacaine spinal block in outpatients undergoing knee arthroscopy.

Methods: One hundred healthy, premedicated patients randomly received conventional bilateral (n = 50) or unilateral (n = 50) spinal anesthesia with 8 mg hyperbaric bupivacaine 0.5%. A lateral decubitus position after spinal injection was maintained in unilateral group for 15 min. Times from spinal injection to readiness for surgery, block resolution, and home discharge were recorded.

Results: Three patients in each group were excluded due to failed block. Readiness for surgery required 13 min (5 – 25 min) with bilateral and 16 min (15 - 30) with unilateral spinal block (P = 0.0005). Sensory and motor blocks on the operated limb were T₉ (T₁₂ – T₂) with a Bromage score 0/1/2/3: 0/2/0/45 in the unilateral group and T₇ (T₁₂ – T₁) with Bromage score 0/1/2/3: 4/1/6/36 with bilateral block (P = 0.026 and P= 0.016, respectively). Vasopressor was required only in five bilateral patients (P = 0.02). Two segment regression of sensory level and home discharge required 81 ± 25 min and 281 ± 83 min with bilateral block, and 99 ± 28 min and 264 ± 95 min with unilateral block (P = 0.002 and P = 0.90, respectively).

Conclusion: Seeking unilateral distribution of spinal anesthesia provided more profound and longer lasting block in the operated limb, less cardiovascular effects, and similar home discharge compared with bilateral spinal anesthesia, with only a slight delay in preparation time.

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