Skip to main content
SpringerLink
Log in

Einseitige Spinalanästhesie

Literaturübersicht und Handlungsempfehlung

Unilateral spinal anesthesia

Literature review and recommendations

  • Regionalanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Die einseitige Spinalanästhesie ist ein kostengünstiges und schnell durchführbares Verfahren. Sie beschränkt sich auf die sensiblen, motorischen und sympathischen Nervenfasern einer Körperseite. Hierdurch können einige für die beidseitige Spinalanästhesie typische Komplikationen umgangen werden. Gerade aufgrund der Vermeidung von Hypotensionen eignet sich das einseitige Verfahren auch für Patienten mit kardiovaskulären Risikofaktoren (z. B. Aortenklappenstenose, koronare Herzkrankheit). Für die zuletzt stark ansteigende Zahl ambulant durchgeführter Operationen galt die Spinalanästhesie bislang als wenig geeignet, da mit verzögerter Entlassung aufgrund prolongierter motorischer Blockade oder Harnverhalt gerechnet werden musste. Die einseitige Spinalanästhesie erlaubt jedoch nicht nur eine raschere Mobilisation der Patienten, sondern geht auch mit einer sehr niedrigen Inzidenz von Miktionsstörungen einher, sodass die Patienten oft sogar früher entlassen werden können als nach einer Allgemeinanästhesie. Der Erfolg dieser Technik wird jedoch durch zahlreiche Faktoren beeinflusst. Neben Konzentration, Barizität und Dosierung des Lokalanästhetikums sind Spinalnadeltyp und Injektionsflussrate ebenso entscheidende Parameter wie die Patientenlagerung. Es stehen verschiedene Adjuvanzien zur Verfügung, mit denen eine längere und intensivere Blockade erzielt werden kann. Nach Auswertung der verfügbaren Literatur zur einseitigen Spinalanästhesie (impact factor > 1) formuliert diese Übersichtsarbeit eine optimierte Vorgehensweise: Um eine tatsächlich einseitige Spinalanästhesie zu erreichen sollte hyperbares Bupivacain 0,5 % mit einer Injektionsflussrate ≤ 0,33 ml/min injiziert werden. Während und 20 min nach Injektion müssen die Patienten mit vollständig gebeugten Beinen und anteflektierter Wirbelsäule auf der zu operierenden Körperseite liegen. Die intrathekale Applikation von 1 ml hyperbarem Bupivacain 0,5 % (5 mg) resultiert in einer einstündigen, bis etwa zum Rückenmarksegment Th12 reichenden Blockade; die Gabe von 1,5 bis 2,0 ml hyperbarem Bupivacain 0,5 % (7,5–10 mg) bis etwa Th6. Zur Verlängerung der Blockadedauer auf 2 bis 3 h wird Clonidin (0,5–1 µg/kgKG) adjuvant injiziert. Während der anschließenden Fixierungszeit kann durch Kopf-Tief- bzw. -Hochlagerung die kraniale Ausbreitung der Spinalanästhesie beeinflusst werden.

Abstract

Unilateral spinal anesthesia is a cost-effective and rapidly performed anesthetic technique. An exclusively unilateral block only affects the sensory, motor and sympathetic functions on one side of the body and offers the advantages of a spinal block without the typical adverse side effects seen with a bilateral block. The lack of hypotension, in particular, makes unilateral spinal anesthesia suitable for patients with cardiovascular risk factors e. g. aortic valve stenosis or coronary artery disease. Increasing numbers of surgical procedures are now being performed on an outpatient basis. Until now, spinal anesthesia has been considered unsuitable for this, not only because of the high incidence of intraoperative hypotension and postoperative urinary retention but also because of the prolonged postoperative stay before home discharge. This is not the case with unilateral spinal anesthesia: motor function returns rapidly, the incidence of urinary retention is extremely low, and patients are usually eligible for home discharge sooner than after bilateral spinal anesthesia or general anesthesia. The success of the technique depends on a number of factors. In addition to the local anesthetic, its concentration and dose, and the baricity of the injected solution, the shape of the spinal needle, the injection speed, the patient’s position during injection, and the time the patient remains in this position after injection are equally important parameters. A number of intrathecally applied adjuvant drugs are used to give a more intense and/or longer-lasting block. For this review, we collated the published data on unilateral spinal anesthesia from journals with an impact factor greater than 1.0 and defined an optimized method for performing the technique. In order to achieve an exclusively unilateral block one should use 0.5 % hyperbaric bupivacaine injected at a rate of 0.33 ml/min or slower. During the injection and the following 20 min the patient should lie in the lateral decubitus position on the side intended for surgery with knees drawn to the chest. An injection of 5 mg (1 ml) hyperbaric bupivacaine 0.5 % provides an hour-long block to T 12, and a dose of 7.5 to 10 mg (1.5–2.0 ml) extends the block to T 6. Adding clonidine (0.5 to 1.0 µg/kg BW) to the injection prolongs the duration of the block to approximately two to three hours. During the 20-minute fixation period, the cephalad spread of the block can be influenced to a certain extent by raising or lowering the head of the table.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Aromaa U, Lahdensuu M, Cozantis DA (1997) Severe complications associated with epidural and spinal anaesthesias in Finland 1987–1993. A study based on patient insurance claims. Acta Anaesthesiol Scand 41(4):445–452

    Article  CAS  PubMed  Google Scholar 

  2. Apaydin Y, Erk G, Sacan O et al (2011) Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection. J Anesth 25(3):380–385

    Article  PubMed  Google Scholar 

  3. Atchison SR, Wedel DJ, Wilson PR (1989) Effect of injection rate on level and duration of hypobaric spinal anesthesia. Anesth Analg 69(4):496–500

    Article  CAS  PubMed  Google Scholar 

  4. Auberger HG, Niesel HC (1982) Praktische Lokalanästhesie – Ein Kompendium, 4. Aufl. Thieme, Stuttgart

    Google Scholar 

  5. Axelsson K, Möllefors K, Olsson JO et al (1985) Bladder function in spinal anaesthesia. Acta Anaesthesiol Scand 29(3):315–321

    Article  CAS  PubMed  Google Scholar 

  6. Baldini G, Bagry H, Aprikian A et al (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157

    Article  PubMed  Google Scholar 

  7. Ben-David B, Levin H, Solomon E et al (1996) Spinal bupivacaine in ambulatory surgery: the effect of saline dilution. Anesth Analg 83(4):716–720

    Article  CAS  PubMed  Google Scholar 

  8. Bergmann I, Hesjedal B, Crozier TA et al (2015) Selective unilateral spinal anaesthesia for outpatient knee arthroscopy using real-time monitoring of lower limb sympathetic tone. Anaesth Intensive Care 43(3):351–356

    CAS  PubMed  Google Scholar 

  9. Bettelli G (2010) Anaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management. Curr Opin Anaesthesiol 23(6):726–731

    Article  PubMed  Google Scholar 

  10. Bigat Z, Boztug N, Karsli B et al (2006) Comparison of hyperbaric ropivacaine and hyperbaric bupivacaine in unilateral spinal anaesthesia. Clin Drug Investig 26(1):35–41

    Article  CAS  PubMed  Google Scholar 

  11. Borghi B, Stagni F, Bugamelli S et al (2003) Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study. J Clin Anesth 15(5):351–356

    Article  PubMed  Google Scholar 

  12. Bourke DL, Sprung J, Harrison C et al (1993) The dribble speed for spinal anesthesia. Reg Anesth 18(5):326–327

    CAS  PubMed  Google Scholar 

  13. Bridenbaugh PO, Kennedy WF (1980) Spinal, subarachnoid neural blockade. In: Cousins MJ, Bridenbaugh PO (Hrsg) Neural blockade – In clinical anesthesia & management of pain. J.B. Lippincott, Philadelphia

    Google Scholar 

  14. Brull SJ, Greene NM (1989) Time-courses of zones of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 69(3):342–347

    Article  CAS  PubMed  Google Scholar 

  15. Bucx MJ, Kroon JW, Stienstra R (1993) Effect of speed of injection on the maximum sensory level for spinal anesthesia using plain bupivacaine 0.5 % at room temperature. Reg Anesth 18(2):103–105

    CAS  PubMed  Google Scholar 

  16. Campagna JA, Carter C (2003) Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 98(5):1250–1260

    Article  PubMed  Google Scholar 

  17. Cappelleri G, Casati A, Fanelli G et al (2000) Unilateral spinal anesthesia or combined sciatic-femoral nerve block for day-case knee arthroscopy. Minerva Anestesiol 66(3):131–136

    CAS  PubMed  Google Scholar 

  18. Cappelleri G, Aldegheri G, Danelli G et al (2005) Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study. Anesth Analg 101(1):77–82

    Article  CAS  PubMed  Google Scholar 

  19. Carson JM, Park WY (1993) Unilateral spinal anesthesia. Reg Anesth 18(25 Suppl):97

    Google Scholar 

  20. Carpenter RL, Caplan RA, Brown DL et al (1992) Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 76(6):906–916

    Article  CAS  PubMed  Google Scholar 

  21. Casati A, Fanelli G (2001) Unilateral spinal anesthesia. State of the art. Minerva Anestesiol 67(12):855–862

    CAS  PubMed  Google Scholar 

  22. Casati A, Fanelli G (2003) Restricting spinal block to the operative side: Why not? Reg Anesth Pain Med 29(1):4–6

    Google Scholar 

  23. Casati A, Fanelli G, Berti M et al (1997) Cardiac performance during unilateral lumbar spinal block after crystalloid preload. Can J Anaesth 44(6):623–628

    Article  CAS  PubMed  Google Scholar 

  24. Casati A, Fanelli G, Cappelleri G et al (1998a) Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth 45(9):850–854

    Article  CAS  PubMed  Google Scholar 

  25. Casati A, Fanelli G, Cappelleri G et al (1998b) Effects of spinal needle type on lateral distribution of 0.5 % hyperbaric bupivacaine. Anesth Analg 87(2):355–359

    CAS  PubMed  Google Scholar 

  26. Casati A, Fanelli G, Cappelleri G et al (1998c) Does speed of intrathecal injection affect the distribution of 0.5 % hyperbaric bupivacaine? Br J Anaesth 81(3):355–357

    Article  CAS  PubMed  Google Scholar 

  27. Casati A, Fanelli G, Beccaria P et al (1998d) Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5 % hyperbaric bupivacaine. A clinical comparison with bilateral spinal block. Minerva Anestesiol 64(7):307–312

    CAS  PubMed  Google Scholar 

  28. Casati A, Fanelli G, Aldegheri G et al (1998e) A transient neurological deficit following intrathecal injection of 1 % hyperbaric bupivacaine for unilateral spinal anaesthesia. Eur J Anaesthesiol 15(1):112–113

    Article  CAS  PubMed  Google Scholar 

  29. Casati A, Fanelli G, Cappelleri G et al (1999a) Effects of speed of intrathecal injection on unilateral spinal block by 1 % hyperbaric bupivacaine. A randomized, double-blind study. Minerva Anestesiol 65(1–2):5–10

    CAS  PubMed  Google Scholar 

  30. Casati A, Fanelli G, Aldegheri G et al (1999b) Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med 24(3):214–219

    CAS  PubMed  Google Scholar 

  31. Casati A, Moizo E, Marchetti C et al (2004) A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy. Anesth Analg 99(5):1387–1392

    Article  CAS  PubMed  Google Scholar 

  32. Chamberlain DP, Chamberlain BDL (1986) Changes in the skin temperature of the trunk and thei relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 65(2):139–143

    Article  CAS  PubMed  Google Scholar 

  33. Concepcion M, Maddi R, Francis D et al (1984) Vasoconstrictors in spinal anesthesia with tetracaine – a comparison of epinephrine and phenylephrine. Anesth Analg 63(2):134–138

    CAS  PubMed  Google Scholar 

  34. De Kock M, Gautier P, Fanard L et al (2001) Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: a dose-response study. Anesthesiology 94(4):574–578

    Article  PubMed  Google Scholar 

  35. Demiraran Y, Yucel I, Akcali GE et al (2008) Adding intrathecal morphine to unilateral spinal anesthesia results in better pain relief following knee arthroscopy. J Anesth 22(4):367–372

    Article  PubMed  Google Scholar 

  36. Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (DIVS) e. V. (Präsident: Prof. Dr. Heinz Laubenthal). S3-Leitlinie: Behandlung akuter perioperativer und posttraumatischer Schmerzen (AWMF-Register Nr. 041/001), Stand: 21.05.2007, inkl. Änderungen vom 20.04.2009, gültig bis 01.04.2014; URL: http://www.awmf.org/uploads/tx_szleitlinien/001-025l_S3_Behandlung_akuter_perioperativer_und_posttraumatischer_Schmerzen_abgelaufen.pdf

  37. Diallo T, Dufeu N, Marret E et al (2009) Walking in PACU after unilateral spinal anesthesia a criteria for hospital discharge: a 100 outpatient survey. Acta Anaesthesiol Belg 60(1):3–6

    CAS  PubMed  Google Scholar 

  38. Dobrydnjov I, Axelsson K, Thörn S‑E et al (2003) Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesth Analg 96(5):1496–1503

    Article  CAS  PubMed  Google Scholar 

  39. Eberhart LH, Morin AM, Kranke P, Geldner G, Wulf H (2002) Transiente neurologische Symptome nach Spinalanästhesie – Eine quantitative systematische Übersicht (Metaanalyse) randomisierter kontrollierter Studien. Anaesthesist 51:539–546

    Article  CAS  PubMed  Google Scholar 

  40. Edelberg R (1977) Relation of electrical properties of skin to structure and physiologic state. J Invest Dermatol 69(3):324–327

    Article  CAS  PubMed  Google Scholar 

  41. Enk D (1995) Voraussetzungen für die bessere Steuerbarkeit einer hyperbaren Feinnadel-Spinalanästhesie – Beobachtungen in einem einfachen Injektionsmodell. Anaesthesist 44(Suppl 1):911–912

    Google Scholar 

  42. Enk D (1998) Unilateral spinal anaesthesia: gadget or tool? Curr Opin Anaesthesiol 11(5):511–515

    Article  CAS  PubMed  Google Scholar 

  43. Enk D, Enk E (1995a) Eine modifizierte Injektionstechnik für die hyperbare Spinalanästhesie. Anaesthesist 44(Suppl 1):110

    Google Scholar 

  44. Enk D, Enk E (1995b) Ein neues Zwei-Kammer-Modell zur Untersuchung und Demonstration transduraler Liquorverluste nach Spinalanästhesien. Anaesthesist 44(11):761–769

    Article  CAS  PubMed  Google Scholar 

  45. Enk D, Prien T, van Aken H et al (2001) Succes of unillateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med 26(5):420–427

    Article  CAS  PubMed  Google Scholar 

  46. Esmaoglu A, Boyaci A, Ersoy Ö et al (1998) Unilateral spinal anaesthesia with hyperbaric bupivacaine. Acta Anaesthesiol Scand 42(9):1083–1087

    Article  CAS  PubMed  Google Scholar 

  47. Esmaoglu A, Karaoglu S, Mizrak A et al (2004) Bilateral vs. unilateral spinal anesthesia for outpatient knee arthroscopies. Knee Surg Sports Traumatol Arthrosc 12(2):155–158

    Article  PubMed  Google Scholar 

  48. Fanelli G, Casati A, Aldegheri G et al (1998) Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand 42(1):80–84

    Article  CAS  PubMed  Google Scholar 

  49. Fanelli G, Borghi B, Casati A et al (2000) Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Can J Anaesth 47(8):746–751

    Article  CAS  PubMed  Google Scholar 

  50. Förster JG (2014) Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anaesthesiol 27(6):597–604

    Article  PubMed  CAS  Google Scholar 

  51. Freedman JM, Li DK, Drasner K et al (1998) Transient neurologic symptoms after spinal anesthesia: an epidemiologic study of 1,863 patients. Anesthesiology 89(3):633–641

    Article  CAS  PubMed  Google Scholar 

  52. Gaiser RR (2013) Postdural puncture headache: a headache for the patient and a headache for the anesthesiologist. Curr Opin Anaesthesiol 26(3):296–303

    Article  CAS  PubMed  Google Scholar 

  53. Gentili ME, Mamelle JC, Le Foll G (1995) Combination of low–dose bupivacaine and clonidine for unilateral spinal anesthesia in arthroscopic knee surgery. Reg Anesth 20(2):169–170

    CAS  PubMed  Google Scholar 

  54. Gissen AJ, Covino BG, Gregus J (1980) Differential sensitivities of mammalian nerve fibers to local anesthetic agents. Anesthesiology 53(6):467–474

    Article  CAS  PubMed  Google Scholar 

  55. Gordh T (1977) Analysis of the sensation of warmth in the lower extremities as the primary effect. Reg Anesth 2(4):5–7

    Google Scholar 

  56. Greene NM (1985) Distribution of local anesthetic solutions within the subarachnoid space. Anesth Analg 64(7):715–730

    Article  CAS  PubMed  Google Scholar 

  57. Greene NM, Brull SJ (1993) Physiology of spinal anesthesia, 4. Aufl. Williams & Wilkins, Baltimore

    Google Scholar 

  58. Gupta A, Axelsson K, Thörn SE et al (2003) Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine. Acta Anaesthesiol Scand 47(1):13–19

    Article  CAS  PubMed  Google Scholar 

  59. Hampl KF, Schneider MC, Ummenhofer W et al (1995) Transient neurologic symptoms after spinal anesthesia. Anesth Analg 81(6):1148–1153

    CAS  PubMed  Google Scholar 

  60. Hampl KF, Schneider MC, Pargger H et al (1996) A similar incidence of transient neurologic symptoms after spinal anesthesia with 2 % and 5 % lidocaine. Anesth Analg 83(5):1051–1054

    Article  CAS  PubMed  Google Scholar 

  61. Hampl K, Steinfeldt T, Wulf H (2014) Spinal anesthesia revisited: toxicity of new and old drugs and compounds. Curr Opin Anaesthesiol 27(5):549–555

    Article  CAS  PubMed  Google Scholar 

  62. Harder HJ (1959) Unilaterale Spinalanaesthesie mit hyperbarer Lösung. Anaesthesist 8(5):145–146

    CAS  PubMed  Google Scholar 

  63. Hocking G, Wildsmith JA (2004) Intrathecal drug spread. Br J Anaesth 93(4):568–578

    Article  CAS  PubMed  Google Scholar 

  64. Horlocker TT, Wedel DJ, Wilson PR (1994) Effect of injection rate on sensory level and duration of hypobaric bupivacaine spinal anesthesia for total hip arthroplasty. Anesth Analg 79(4):773–777

    Article  CAS  PubMed  Google Scholar 

  65. Horlocker TT, Hebl JR (2003) Anesthesia for outpatient knee arthroscopy: Is there an optimal technique? Reg Anesth Pain Med 28(1):58–63

    PubMed  Google Scholar 

  66. Iselin-Chaves IA, Van Gessel EF, Donald FA et al (1996) The effects of solution concentration and epinephrine on lateral distribution of hyperbaric tetracaine spinal anesthesia. Anesth Analg 83(4):755–759

    Article  CAS  PubMed  Google Scholar 

  67. Janitzki A, Götte A (1986) Hautwiderstandsmessungen zum Aktivitätsnachweis des Sympathicus bei der Spinalanästhesie. Reg Anaesth 9(2):49–53

    CAS  PubMed  Google Scholar 

  68. Janitzki A, Götte A (1990) Die Funktion des Sympathikus und sein Verhalten bei Regionalanästhesien. Reg Anaesth 13(3):91–94

    CAS  PubMed  Google Scholar 

  69. Janitzki A, Götte A (1995) Spinalanästhesie und funktionelle Sympthikusblockade. Anaesthesist 44(3):171–177

    Article  CAS  PubMed  Google Scholar 

  70. Kalagac FL, Koseto A (2004) Unilateral spinal anaesthesia: hypobaric or hyperbaric block? Reg Anesth Pain Med 29(5):9

    Article  Google Scholar 

  71. Kamphuis ET, Ionescu TI, Kuipers PW et al (1998) Recovery of storage and emptying functions of the urinary bladder after spinal anesthesia with lidocaine and with bupivacaine in men. Anesthesiology 88(2):310–316

    Article  CAS  PubMed  Google Scholar 

  72. Karacalar S, Türe H, Sarihasan B (2008) Unilateral spinal anesthesia in two centenarian patients. J Clin Anesth 20(6):452–454

    Article  PubMed  Google Scholar 

  73. Kaya M, Oguz S, Aslan K et al (2004) A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia. Reg Anesth Pain Med 29(1):17–22

    CAS  PubMed  Google Scholar 

  74. Khatouf M, Loughnane F, Boini S et al (2005) Unilateral spinal anaesthesia in elderly patient for hip trauma: a pilot study. Artikel in französischer Sprache. Ann Fr Anesth Reanim 24(3):249–254

    Article  CAS  PubMed  Google Scholar 

  75. Kim JT, Lee JH, Cho CW et al (2013) The influence of spinal flexion in the lateral decubitus position on the unilaterality of spinal anesthesia. Anesth Analg 117(4):1017–1021

    Article  PubMed  Google Scholar 

  76. Kiran S, Upma B (2004) Use of small-dose bupivacaine (3 mg vs 4 mg) for unilateral spinal anesthesia in the outpatient setting. Anesth Analg 99(1):302–303

    Article  PubMed  Google Scholar 

  77. Kopp SL, Horlocker TT (2010) Regional anesthesia in day-stay and short-stay surgery. Anaesthesia 65(Suppl 1):84–96

    Article  PubMed  Google Scholar 

  78. Korhonen AM (2006) Use of spinal anaesthesia in day surgery. Curr Opin Anaesthesiol 19(6):612–616

    Article  PubMed  Google Scholar 

  79. Korhonen AM, Valanne JV, Jokela RM et al (2003a) Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 µg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand 47(3):342–346

    Article  CAS  PubMed  Google Scholar 

  80. Korhonen AM, Valanne JV, Jokela RM et al (2003b) Ondansetron does not prevent pruritus induced by low-dose intrathecal fentanyl. Acta Anaesthesiol Scand 47(10):1292–1297

    Article  CAS  PubMed  Google Scholar 

  81. Korhonen AM, Valanne JV, Jokela RM et al (2004) A comparison of selective spinal anesthesia with hyperbaric bupivacaine and general anesthesia with desflurane for outpatient knee arthroscopy. Anesth Analg 99(6):1668–1673

    Article  PubMed  Google Scholar 

  82. Korhonen AM, Valanne JV, Jokela RM et al (2005) Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anesthesia for ambulatory knee arthroscopy. Acta Anaesthesiol Scand 49(1):72–77

    Article  PubMed  Google Scholar 

  83. Kuipers PW, Kamphuis ET, van Venrooij GE et al (2004) Intrathecal opioids and lower urinary tract function: a urodynamic evaluation. Anesthesiology 100(6):1497–1503

    Article  CAS  PubMed  Google Scholar 

  84. Kuusniemi KS, Pihlajamäki KK, Pitkänen MT et al (1997) A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies. Reg Anesth 22(6):534–538

    CAS  PubMed  Google Scholar 

  85. Kuusniemi KS, Pihlajamäki KK, Irjala JK et al (1999a) Restricted spinal anaesthesia for ambulatory surgery: a pilot study. Eur J Anaesthesiol 16(1):2–6

    Article  CAS  PubMed  Google Scholar 

  86. Kuusniemi KS, Pihlajamäki KK, Pitkänen MT et al (1999b) Low dose bupivacaine: a comparison of hypobaric and near isobaric solutions for arthroscopic surgery of the knee. Anaesthesia 54(6):540–545

    Article  CAS  PubMed  Google Scholar 

  87. Kuusniemi KS, Pihlajamäki KK, Pitkänen MT (2000) A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med 25(6):605–610

    Article  CAS  PubMed  Google Scholar 

  88. Kuusniemi KS, Pihlajamäki KK, Kirvelä OA et al (2001) Spinal anesthesia with hypobaric bupivacaine for knee arthroscopies: effect of posture on motor block. Reg Anesth Pain Med 26(1):30–34

    CAS  PubMed  Google Scholar 

  89. Liu SS (1997) Optimizing spinal anesthesia for ambulatory surgery. Reg Anesth 22(6):500–510

    CAS  PubMed  Google Scholar 

  90. Liu SS, McDonald SB (2001) Current issues in spinal anesthesia. Anesthesiology 94(5):888–906

    Article  CAS  PubMed  Google Scholar 

  91. Liu SS, Ware PD, Allen HW et al (1996) Dose-response characteristics of spinal bupivacaine in volunteers. Anesthesiology 85(4):729–736

    Article  CAS  PubMed  Google Scholar 

  92. Liu SS, Strodtbeck WM, Richman JM et al (2005) A comparison of regional versus general anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 101(6):1634–1642

    Article  PubMed  Google Scholar 

  93. Lund PC, Rumball AC (1947) Hypobaric pontocaine spinal anaesthesia; 1,640 consecutive cases. Anesthesiology 8(2):181–199

    Article  CAS  PubMed  Google Scholar 

  94. Macefield VG, Elam M, Wallin BG (2002) Firing properties of single postganglionic sympathetic neurones recorded in awake human subjects. Auton Neurosci 95(1–2):146–159

    Article  PubMed  Google Scholar 

  95. Malinovsky JM, Charles F, Kick O et al (2000) Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg 91(6):1457–1460

    Article  CAS  PubMed  Google Scholar 

  96. Manassero A, Bossolasco M, Ugues S et al (2014) Comparison of unilateral and bilateral spinal anesthesia with 2 % hyperbaric prilocaine in day-case inguinal herniorrhaphy: a randomized controlled trial. Minerva Anestesiol 80(6):685–691

    CAS  PubMed  Google Scholar 

  97. Martin-Salvaj G, Van Gessel E, Forster A et al (1994) Influence of duration of lateral decubitus on the spread of hyperbaric tetracaine during spinal anesthesia: a prospective time-response study. Anesth Analg 79(6):1107–1112

    Article  CAS  PubMed  Google Scholar 

  98. McClure JH, Brown DT, Wildsmith JA (1982) Effect of injected volume and speed of injection on the spread of spinal anaesthesia with isobaric amethocaine. Br J Anaesth 54(9):917–920

    Article  CAS  PubMed  Google Scholar 

  99. McDonald SB, Liu SS, Kopacz DJ et al (1999) Hyperbaric spinal ropivacaine: a comparison to bupivacaine in volunteers. Anesthesiology 90(4):971–977

    Article  CAS  PubMed  Google Scholar 

  100. Merivirta R, Kuusniemi K, Jaakkola P et al (2009) Unilateral spinal anaesthesia for outpatient surgery: a comparison between hyperbaric bupivacaine and bupivacaine-clonidine combination. Acta Anaesthesiol Scand 53(6):788–793

    Article  CAS  PubMed  Google Scholar 

  101. Meyer J, Enk D, Penner M (1996) Unilateral spinal anesthesia using low-flow injection through a 29-Gauge Quincke needle. Anesth Analg 82(6):1188–1191

    CAS  PubMed  Google Scholar 

  102. Moore DC (1980) Spinal anesthesia: bupivacaine compared with tetracaine. Anesth Analg 59(10):743–750

    Article  CAS  PubMed  Google Scholar 

  103. Mulroy MF, Salinas FV, Larkin KL et al (2002) Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 97(2):315–319

    Article  PubMed  Google Scholar 

  104. Myler CS, Gupta RK (2015) Spinal anesthesia in a patient with a history of systemic capillary leak syndrome (Clarkson Disease). Reg Anesth Pain Med. doi:10.1097/aap.0000000000000302

    PubMed  Google Scholar 

  105. Nair GS, Abrishami A, Lermitte J et al (2009) Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth 102(3):307–315

    Article  CAS  PubMed  Google Scholar 

  106. Neigh JL, Kane PB, Smith TC (1970) Effects of speed and direction of injection on the level and duration of spinal anesthesia. Anesth Analg 49(6):912–918

    Article  CAS  PubMed  Google Scholar 

  107. Niemi L (1994) Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand 38(7):724–728

    Article  CAS  PubMed  Google Scholar 

  108. Nolte H, Meyer J, Köpf B, Zenz M (1974) Klinische und elektrophysiologische Parameter zur Differenzierung der Wirkung von Lokalanaesthetica. Anaesthesist 23(4):165–177

    CAS  PubMed  Google Scholar 

  109. Penno A, Arumugam M, Antweiler G et al (2012) Hauttemperaturerhöhungen bei Spinalanästhesie. Prädiktiver Wert als Vorhersagewahrscheinlichkeit einer chirurgischen Toleranz. Anaesthesist 61(9):770–776

    Article  CAS  PubMed  Google Scholar 

  110. Pittoni G, Toffoletto F, Calcarella G et al (1995) Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg 81(1):73–79

    CAS  PubMed  Google Scholar 

  111. Pollock JE (2003) Neurotoxicity of intrathecal local anaesthetics and transient neurological symptoms. Best Pract Res Clin Anaesthesiol 17(3):471–484

    Article  CAS  PubMed  Google Scholar 

  112. Pollock JE, Mulroy MF, Bent E et al (2003) A comparison of two regional anesthetic techniques for outpatient knee arthroscopy. Anesth Analg 97(2):397–401

    Article  PubMed  Google Scholar 

  113. Povey HM, Olsen PA, Pihl H (1987) Spinal analgesia with hyperbaric 0.5 % bupivacaine: effects of different patient positions. Acta Anaesthesiol Scand 31(7):616–619

    Article  CAS  PubMed  Google Scholar 

  114. Povey HM, Jacobsen J, Westergaard-Nielsen J (1989) Subarachnoid analgesia with hyperbaric 0.5 % bupivacaine: effect of a 60-min period of sitting. Acta Anaesthesiol Scand 33(4):295–297

    Article  CAS  PubMed  Google Scholar 

  115. Pumberger M, Memtsoudis SG, Stundner O et al (2013) An analysis of the safety of epidural and spinal neuraxial anesthesia in more than 100,000 censecutive major lower extremity joint replacements. Reg Anesth Pain Med 38(6):515–519

    Article  CAS  PubMed  Google Scholar 

  116. Puronto M (1975) Hyperbares Bupivacan 1 % (Marcain®/Carbostesin® schwer) bei orthopädischen Hemispinalanästhesien. Anaesthesist 24(9):408–411

    CAS  PubMed  Google Scholar 

  117. Racle JP, Benkhadra A, Poy JY et al (1987) Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg 66(5):442–446

    Article  CAS  PubMed  Google Scholar 

  118. Radke K, Radke OC (2013) Postpunktioneller Kopfschmerz. Anaesthesist 62(2):149–161

    Article  CAS  PubMed  Google Scholar 

  119. Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321(7275):1493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Sato K, Kang WH, Saga K et al (1989) Biology of sweat glands and their disorders. I. Normal sweat gland function. J Am Acad Dermatol 20(4):537–563

    Article  CAS  PubMed  Google Scholar 

  121. Schneider M, Ettlin T, Kaufmann M et al (1993) Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5 % lidocaine. Anesth Analg 76(5):1154–1157

    Article  CAS  PubMed  Google Scholar 

  122. Serpell MG, Gray WM (1997) Flow dynamics through spinal needles. Anaesthesia 52(3):229–236

    Article  CAS  PubMed  Google Scholar 

  123. Singh TK, Anabarsan A, Srivastava U et al (2014) Unilateral spinal anaesthesia for lower limb orthopaedic surgery using low dose Bupivacaine with Fentanyl or Clonidine: A randomised control study. J Anesth Clin Res 5(12):484. doi:10.4172/2155-6148.1000484

    Google Scholar 

  124. Snyder JJ (1951) Hypobaric spinal anesthesia: a review of the literature and some clinical observations. Anesthesiology 12(3):301–307

    Article  CAS  PubMed  Google Scholar 

  125. Stienstra R, Van Poorten F (1990) Speed of injection does not affect subarachnoid distribution of plain bupivacaine 0.5. Reg Anesth 15(4):208–210

    CAS  PubMed  Google Scholar 

  126. Tarkkila PJ, Kaukinen S (1991) Complications during spinal anesthesia: a prospective study. Reg Anesth 16(2):101–106

    CAS  PubMed  Google Scholar 

  127. Tarkkila P, Huhtala J, Tuominen M (1997) Home-readiness after spinal anaesthesia with small doses of hyperbaric 0.5 % bupivacaine. Anaesthesia 52(12):1157–1160

    Article  CAS  PubMed  Google Scholar 

  128. Takiguchi T, Yamaguchi S, Okuda Y et al (2004a) Deviation of the cauda equina by changing position. Anesthesiology 100(3):754–755

    Article  PubMed  Google Scholar 

  129. Takiguchi T, Yamaguchi S, Hashizume Y et al (2004b) Movement of the Cauda Equina during the lateral decubitus position with fully flexed leg. Anesthesiology 101(5):1250

    Article  PubMed  Google Scholar 

  130. Tanasichuk MA, Schultz EA, Matthews JH et al (1961) Spinal hemianalgesia: an evaluation of a method, its applicability, and influence on the incidence of hypotension. Anesthesiology 22:74–85

    Article  CAS  PubMed  Google Scholar 

  131. Tosun F, Ozen M, Tatar C et al (2015) Unilateral spinal anesthesia experience in a supercentenarian. A A Case Rep 5(7):117–118

    Article  PubMed  Google Scholar 

  132. Tuominen M (1991) Bupivacaine spinal anaesthesia. Acta Anaesthesiol Scand 35(1):1–10

    Article  CAS  PubMed  Google Scholar 

  133. Urbanek B, Kapral S (2006) Levobupivacain in der Regionalanästhesie. Anaesthesist 55(3):296–313

    Article  CAS  PubMed  Google Scholar 

  134. Urman RD, Desai SP (2012) History of anesthesia for ambulatory surgery. Curr Opin Anaesthesiol 25(6):641–647

    PubMed  Google Scholar 

  135. Urman RD, Punwani N, Shapiro FE (2012) Patient safety and office-based anesthesia. Anesth Analg 25(6):648–653

    Google Scholar 

  136. Valanne JV, Korhonen AM, Jokela RM et al (2001) Selective spinal anesthesia: a comparison of hyperbaric bupivacaine 4 mg versus 6 mg for outpatient knee arthroscopy. Anesth Analg 93(6):1377–1379

    Article  CAS  PubMed  Google Scholar 

  137. Voelckel WG, Kirchmair L, Rehder P et al (2009) Unilateral anesthesia does not affect the incidence of urinary retention after low-dose spinal anesthesia for knee surgery. Anesth Analg 109(3):986–987

    Article  PubMed  Google Scholar 

  138. White PF (2000) Ambulatory anesthesia advances into the new millenium. Anesth Analg 90:1234–1235

    Article  CAS  PubMed  Google Scholar 

  139. Whiteside JB, Burke D, Wildsmith JA (2003) Comparison of ropivacaine 0.5 % (in glucose 5 %) with bupivacaine 0.5 % (in glucose 8 %) for spinal anaesthesia for elective surgery. Br J Anaesth 90(3):304–308

    Article  CAS  PubMed  Google Scholar 

  140. Winterhalter M, Schiller J, Münte S et al (2008) Prospective investigation into the influence of various stressors on skin impedance. J Clin Monit Comput 22(1):67–74

    Article  PubMed  Google Scholar 

  141. Wolff M, Heugel P, Hempelmann G et al (2007) Clonidine reduces the excitability of spinal dorsal horn neurones. Br J Anaesth 98(3):353–361

    Article  CAS  PubMed  Google Scholar 

  142. Wulf H, Kessler P, Steinfeldt T et al (2013) S1-Leitlinie – Empfehlungen zur Durchführung der Spinalanästhesie bei ambulanten Patienten. Anasth Intensivmed 54:552–555

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch Str. 40, 37075, Göttingen, Deutschland

    B. Büttner, M. Bauer, J. Hinz & I. Bergmann

  2. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    A. Mansur

Authors
  1. B. Büttner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Mansur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Bergmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Büttner.

Ethics declarations

Interessenkonflikt

B. Büttner, A. Mansur, M. Bauer, J. Hinz und I. Bergmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Büttner, B., Mansur, A., Bauer, M. et al. Einseitige Spinalanästhesie. Anaesthesist 65, 847–865 (2016). https://doi.org/10.1007/s00101-016-0232-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-016-0232-x

Schlüsselwörter

Keywords

Search

Navigation