BJA Advance Access published online on October 29, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei015
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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1 Department of Anaesthesia and Intensive Care, Tartu University Clinics, Tartu, Estonia
* To whom correspondence should be addressed. 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.
Clinical Investigation
Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery
2 Department of Anaesthesiology and Intensive Care, Turku University Hospital, Turku, Finland
A. Sell, E-mail: andres.sell{at}kliinikum.ee
Abstract 
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