Comparison of unilateral and bilateral spinal anesthesia with 2% hyperbaric prilocaine in day-case inguinal herniorrhaphy: a randomized controlled trial.
Abstract
BACKGROUND:
Hyperbaric 2% prilocaine produces a faster onset and shorter duration of spinal
anesthesia than a plain solution. The anesthetic profile could be
improved by restricting the block to the operative side. We compared
unilateral versus conventional bilateral spinal anesthesia with hyperbaric 2% prilocaine in day-case patients undergoing unilateral inguinal herniorrhaphy.
METHODS:
Eighty patients were randomly assigned to receive either conventional bilateral (N.=40) or unilateral (N.=40) spinal anesthesia with 50 mg hyperbaric prilocaine
2%. In the unilateral group, lateral decubitus was maintained for 10
minutes. Sensory and motor block courses, time to first micturition, and
side effects were recorded.
RESULTS:
On the operated
side, the highest sensory block was T8 (T12-T2) in the unilateral and T9
(T11-T4) in the bilateral group (P=0.0328); the time to motor (115 ± 26
min in the unilateral and 108 ± 24 min in the bilateral groups,
P=0.2350) and sensory (156 ± 30 min in the unilateral and 158 ± 26 min
in the bilateral groups, P=0.7550) block resolution was similar in both
groups. On the non-operated side, the unilateral group had a faster
motor (64 ± 48, P<0.001) and sensory (120 ± 47, P<0.001) time to
block resolution than the conventional group. Restricted unilateral
motor and sensory block was achieved in 30% and 12.5% of patients,
respectively. Time to voiding was shorter in the unilateral than in the
conventional group (220 ± 47 vs. 249 ± 51 min, respectively, P=0.0104).
There were no significant differences in adequacy for surgery and side
effects between the groups.
CONCLUSION:
In day-case inguinal herniorrhaphy, attempting unilateral spinal anesthesia with 50 mg hyperbaric 2% prilocaine produced faster time to voiding.
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