Plain Versus Hyperbaric Ropivacaine for Spinal Anesthesia in Cirrhotic Patients Undergoing Ano-rectal Surgery

Background: In cirrhotic patients undergoing ano-rectal surgery, spinal anesthesia/analgesia remains a challenge. Coagulopathy and intraoperative hypotension represent a major challenge for the anesthetist during spinal anesthesia in those patients. This study was designed to examine the efficacy and the adverse effects of ropivacaine (plain, hyperbaric) spinal anesthesia for anorectal surgery in cirrhotic. Material and Methods: Forty known cirrhotic patients categorized as Child-A, scheduled for anorectal surgery under spinal anesthesia were enrolled in this study. Patients were randomly allocated into 2 equal groups. Patients received 2.0 ml ropivacaine 0.6% (6 mg/ml), either in plain solution (group I) or with glucose (hyperbaric) group II. 10μg fentanyl was added for each solution. The extent and duration of sensory and motor block, pulse rate, blood pressure, and time to mobilization were recorded. Any unwanted effects related to spinal blockade were also recorded. Results: There were significant differences in median time to onset of sensory block at T10 (plain 9 min; hyperbaric 3 min; P<0.01), median maximum extent (plain T8; hyperbaric T6; P<0.05), and median duration of sensory block at T10 (plain 66 min; hyperbaric 113 min; P<0.01). However, median times to complete regression of both sensory (183 vs 156 min; P<0.05) and motor (158 vs 123 min; P<0.05) block were longer in the plain group. Patients mobilized sooner in the hyperbaric group (plain 192 vs hyperbaric 131 min; P<0.01). All the hyperbaric blocks were adequate for surgery, but three patients receiving plain ropivacaine required sedative/analgesic bolus during anal dilatation. Conclusion: The practice of spinal anesthesia in patients with mild cirrhosis is a safe and reliable anesthetic technique. Addition of glucose 50 mg/ml to plain ropivacaine 6% increases the speed of onset, block reliability, duration of useful block for ano-rectal surgery, and speed of recovery. Moreover hemodynamic stability is a prominent feature of that block.