Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents

In a double-blind study, 90 patients (ASA 1 or 2) received spinal anaesthesia with 2 ml hyperbaric cinchocaine 0.5%, 4 ml hyperbaric bupivacaine 0.5% or 4 ml plain bupivacaine 0.5%. All injections were made in the left lateral position, and the patients turned supine immediately. Hyperbaric bupivacaine produced a significantly faster and a higher dermatomal level of bilateral complete sensory blockade than the other solutions (p less than 0.005 for each). The duration of sensory blockade was significantly longer with plain bupivacaine than with either hyperbaric solution (p less than 0.0005). The intensity of sensory blockade was significantly greater with both bupivacaine solutions than with hyperbaric cinchocaine (p less than 0.05). Onset and intensity of motor blockade were similar with all agents, but motor blockade was of significantly shorter duration with hyperbaric bupivacaine than the other agents (p less than 0.0005). Hyperbaric bupivacaine appears to be the best agent for rapid and intense sensory blockade of intermediate duration. Plain bupivacaine is more appropriate if a longer duration of action but a lower height of blockade are required, and has the advantage of less cardiovascular disturbance.