The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%

This study compared the haemodynamic effects of subarachnoid block with plain bupivacaine 0.5% (dextrose-free), heavy bupivacaine 0.5% (in dextrose 8%) and a mixture of these two solutions, i.e. bupivacaine 0.5% in dextrose 4%. Thirty-six male patients, aged 55-89 years, undergoing transurethral surgery were recruited. Invasive systolic arterial and central venous pressures were recorded at 5-s intervals after the block was initiated using a computerised data-collection system. The height of sensory blockade was recorded at 5-min intervals. No preload was given and episodes of hypotension were treated with colloid (8 ml x kg(-1)) and, if this was ineffective, a metaraminol infusion. Systolic arterial and central venous pressures decreased in all three groups following block (p < 0.05). These decreases were more rapid in onset in the heavy bupivacaine group compared with plain bupivacaine group (p < 0.005). Patients in the heavy bupivacaine group also had a greater requirement for early treatment of hypotension (< 10 min) and treatment with metaraminol (p < 0.05). The onset of sensory blockade was more rapid in the heavy group compared with the mixed group, although final sensory levels were similar. The onset of haemodynamic and sensory changes are more rapid when using heavy bupivacaine intrathecally. This leads to a higher and earlier incidence of hypotension and requirement for treatment.