The Anesthetic and Recovery Profiles of Low-dose Hypobaric Bupivacaine in Spinal Anesthesia Injected in the L5-S1 Space for Total Hip and Knee Arthroplasty

Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Observational
SUMMARY

Patients going through total hip or knee replacement (arthroplasty) have to be put under spinal anesthesia to prevent them from feeling any pain during surgery. Spinal anesthesia means having a small needle inserted between the bones of the lower lumbar spine (vertebrae). The choice of space used is decided by the anesthesiologist in charge of patient care. The space between these bones is often narrowed by arthritis or other age-related degenerative spine disease in patients having total hip or knee replacement surgery. The lowest L5-S1 (Lumbar 5- Sacral 1) space is the largest one and often least affected by arthritis, which makes it the easiest option. Despite this, it is not currently the most common space used for spinal anesthesia, because it is hard to find by palpation (feeling the bones through the skin), and because there is concern that local anesthetic will not always spread up high enough from this lowest space, which is needed for a successful spinal anesthesia. How far it spreads depends on the amount (dose) and density of local anesthetic given. There are two types of local anesthetic: one called isobaric, which has the same density as CSF (Cerebro-Spinal Fluid), and another called hypobaric, which has lower density than CSF. Isobaric local anesthetic spreads evenly throughout the CSF irrespective of patient positioning. However, a larger dose is required to achieve adequate anesthesia for surgery. Using larger doses, leads to a very long duration of sensory and motor block, far in excess of that required for surgical completion which leads to a slower recovery from anesthesia. Hypobaric local anesthetic, on the other hand, floats in CSF like oil on water. This allows anesthesiologists to use a smaller dose while still being sure that it will spread high enough to achieve adequate anesthesia for surgery. The smaller doses in turn allow for faster recovery of normal movement and feeling in the legs of patients after surgery. It has been observed that all of these dilemma can be solved by: 1. Using ultrasound imaging to find and mark the space, and 2. Injecting hypobaric local anesthetic. The goal of this observational study is to determine the success rate of spinal anesthesia with a lower dose of hypobaric bupivacaine injected into the L5-S1 space, when done on total hip or knee arthroplasty patients at Toronto Western Hospital.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 20
Healthy Volunteers: f
View:

• Patients undergoing elective unilateral total hip or knee arthroplasty under spinal anesthesia at TWH who are scheduled for inpatient overnight admission

• American Society of Anesthesiologists physical status class (ASA-PS) 1-3

• At least 20 years of age

Locations
Other Locations
Canada
Toronto Western Hospital
RECRUITING
Toronto
Contact Information
Primary
Jayanta Chowdhury, MBBS,MD
jayanta.chowdhury@uhn.ca
416-603-5800
Time Frame
Start Date: 2024-07-22
Estimated Completion Date: 2025-06-30
Participants
Target number of participants: 55
Treatments
Hypobaric L5-S1 Spinal Anesthesia
Will receive a dose of hypobaric (0.33%) bupivacaine, administered at the L5-S1 space.
Related Therapeutic Areas
Sponsors
Leads: University Health Network, Toronto

This content was sourced from clinicaltrials.gov