Comparison of hemodynamic parameters in patients during transcuretral resection of the urinary bubble during spinal anesthesia using levobupivakaina and popivacaine

Abstract

Summary. The aim of the study was to compare hemodynamic changes when using ropivacaine and levobupivacaine in patients during spinal anesthesia. Materials and methods: The study included 48 patients who were randomized into two groups, depending on the anesthetic used: group P – ropivacaine, group L – levobupivacaine. Changes in mean arterial pressure and heart rate were evaluated. Results: patients in group L showed stable hemodynamic parameters. On the contrary, in the group P for 12 min, arterial hypotension was registered in 45.8% of the subjects, for 15 min it was detected in 37.5% of cases. At 18 min, a decrease in mean arterial pressure was observed in 41.6% of patients, while in 12.5% of cases it was necessary to connect vasopressor support for norepinephrine in a dosage of 0.07–0.15 μg/kg/min. When analyzing the heart rate of less than 60 beats/min in group L was not identified. At the same time, in group P, sinus bradycardia was registered at all stages of control of the heart rate, and in some cases atropine correction was required. Conclusions: the course of anesthesia in the group using levobupivacaine was characterized by stable mean arterial pressure and heart rate. Patients in the ropivacaine group showed a decrease in mean arterial pressure of less than 70 mm Hg. in a controlled period of time from 12.5% to 48.5% for the purpose of correction of which, use of vasopressor support was required by 12.5%. Bradycardia in this group was registered in 12.5% -54.1% of cases, while atropine was used in 12.5%.

Keywords

levobupivacaine / ropivacaine / spinal anesthesia / transurethral resection of the bladder / bradycardia / hypotension

References

[1] Korobkin A.S., Ternovoy S.K., Pushkar D.Yu. Comprehensive diagnosis of bladder cancer. Russian electronic journal of radiology. 2012; 2 (4): 74–8. (in Russian).

[2] Коробкин А.С., Терновой С.К., Пушкарь Д.Ю. Комплексная диагностика рака мочевого пузыря. Российский электронный журнал лучевой диагностики. 2012; 2 (4): 74–8.

[3] Goryachev R.V., Gruzdev V.E., Rychkov I.A. Experience with levobupivacaine for spinal anesthesia for urological interventions. Regional anesthesia and acute pain treatment. 2018; 12 (1): 30–6. (in Russian).

[4] Горячев Р.В., Груздев В.Е., Рычков И.А. Опыт применения левобупивакаина для спинальной анестезии при урологических вмешательствах. Регионарная анестезия и лечение острой боли. 2018; 12 (1): 30–6.

[5] Baydilek Y., Yurtlu B.S., Hanci V. The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery. Braz. J. Anesthesiol. 2014; 64 (2): 89–97. DOI: 10.1016/j.bjane.2013.03.007.

[6] Lee Y.Y., Muchhal K., Chan C.K., Cheung A.S. Levobupivacaine and fentanyl for spinal anaesthesia: a randomized trial. Eur. J. Anaesthesiol. 2005; 22 (12): 899–903.

[7] Carpenter R.L., Caplan R.A., Brown D.L., Stephenson C. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992; 76 (6): 906–16.

[8] Dyamanna D.N., Zacharia B.T. Unexpected bradycardia and cardiac arrest under spinal anesthesia: case reports and review of literature. Middle East J. Anaesthesiol. 2013; 22 (1): 121–5.

[9] Klimscha W., Weinstabl C., Ilias W., Mayer N. Continuous spinal anesthesia with a microcatheter and low-dose bupivacaine decreases the hemodynamic effects of centroneuraxis blocks in elderly patients. Anesth. Analg. 1993; 77 (2): 275–80.

[10] Shchegolev A.V., Tsygankov K.A., Lakhin R.E. Analysis of the frequency of critical incidents during planned surgery on the abdominal organs. Bulletin of the Russian Military Medical Academy. 2016; 1 (53): 29–32.

[11] Щеголев А.В., Цыганков К.А., Лахин Р.Е. Анализ частоты критических инцидентов при плановых оперативных вмешательствах на органах брюшной полости. Вестник Российской Военно-медицинской академии. 2016; 1 (53): 29–32.

[12] Akcaboy E.Y., Akcaboy Z.N., Gogus N.J. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. Res. Med. Sci. 2011; 16 (1): 68–73.

[13] Akcaboy E.Y., Akcaboy Z.N., Gogus N.J. Low dose levobupivacaine 0.5% with fentanyl in spinal anaesthesia for transurethral resection of prostate surgery. Res Med Sci. 2011; 16 (1): 68–73.

[14] Foster R.H., Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000; 59 (3): 551–79.

[15] Erdil F., Bulut S., Demirbilek S. The effects of intrathecal levobupivacaine and bupivacaine in the elderly. Anaesthesia. 2009; 64 (9): 942–6. DOI: 10.1111/j.1365-2044.2009.05995.

[16] Seetharam K.R., Bhat G. Effects of isobaric ropivacaine with or without fentanyl in subarachnoid blockade: A prospective double-blind, randomized study. Anesth. Essays Res. 2015; 9 (2): 173–7. doi: 10.4103/0259-1162.152149.

[17] Chaudhary A., Bogra J., Singh P.K. Efficacy of spinal ropivacaine versus ropivacaine with fentanyl in transurethral resection operations. Saudi J. Anaesth. 2014; 8 (1): 88–91. DOI: 10.4103/1658-354X.125951.

[18] Cuvas O., Basar H., Yeygel A. Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl. Middle East J. Anaesthesiol. 2010; 20 (4): 547–52.

[19] Lee Y.Y., Ngan Kee W.D., Muchhal K. Randomized double-blind comparison of ropivacaine-fentanyl and bupivacaine-fentanyl for spinal anaesthesia for urological surgery. Acta Anaesthesiol. Scand. 2005; 49 (10): 1477–82.

RIGHTS & PERMISSIONS

Eco-Vector