BJA Advance Access originally published online on October 29, 2004
British Journal of Anaesthesia 2005 94(2):239-242; doi:10.1093/bja/aei015
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery
1 Department of Anaesthesia and Intensive Care, Tartu University Clinics, Tartu, Estonia. 2 Department of Anaesthesiology and Intensive Care, Turku University Hospital, Turku, Finland
* Corresponding author: Department of Anaesthesia and Intensive Care, Tartu University Clinics, 8 L. Puusepp Street, 51014 Tartu, Estonia. E-mail: andres.sell{at}kliinikum.ee
Background. Continuous spinal anaesthesia with spinal catheters allows incremental dosing of local anaesthetic and, consequently, less haemodynamic changes. However, little is known about the required doses. Therefore, we designed a study to assess the minimum effective local anaesthetic dose (MLAD) of levobupivacaine and ropivacaine in this context.
Methods. Forty-one patients undergoing hip replacement surgery were randomly allocated to one of the two local anaesthetic groups in a double-blind manner. The initial dose of local anaesthetic was determined by the response of the previous patient: the effective dose resulted in a 1 mg decrease in the dose of levobupivacaine or ropivacaine, and an ineffective dose resulted in a 1 mg increase. The MLAD was calculated by the Dixon up-and-down method.
Results. The MLAD of levobupivacaine was 11.7 mg (95% CI, 11.1–12.4) and that of ropivacaine 12.8 mg (95% CI, 12.2–13.4).
Conclusions. These doses are significantly smaller than doses reported before for single-shot spinal anaesthesia. Continuous spinal anaesthesia allows the use of relatively small doses of local anaesthetic.
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