Table 2.
Characteristics of spinal anesthesia in the included studies
| Study | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Errando et al. [29] | Ben David et al. [30] | Olofsson et al. [31] | Martyr et al. [32] | Kahloul et al. [33] | Lilot et al. [34] | |||||||||
| Anesthetic |
Hyper Bupivacaine 0.25% |
Hyper Bupivacaine 0.5% |
Hyper Bupivacaine 0.5% |
Hyper Bupivacaine 0.5% |
Hypo Bupivacaine 0.5% |
Hypo Bupivacaine 0.5% |
Iso-hypo ropivacaine 0.75% |
|||||||
| Dose (mg) | 3.75 | 7.5 | 4 | 10 | 7.5 | 15 | 9 | 11 | 5 | 7.5 | 6 | 8 | 10 | 12 |
| Subgroup | L | H | L | H | L | H | L | H | L | H | L | L | H | H |
| Adjuvant (opiate) | N/A | N/A | Fentanyl | N/A | Sufentanil | N/A | Fentanyl | N/A | Fentanyl | Fentanyl | Sufentanil | Sufentanil | Sufentanil | Sufentanil |
| Adjuvant dose (mcg) | - | - | 20 | - | 5 | - | 20 | - | 25 | 25 | 5 | 5 | 5 | 5 |
| Puncture level |
L2–L3 L3–L4 |
L2–L3 L3–L4 |
L3–L4 | L3–L4 | L2–L3 | L2–L3 | L3–L4 | L3–L4 |
L3–L4 L4–L5 |
L3–L4 L4–L5 |
L3–L4 L4–L5 |
L3–L4 L4–L5 |
L3–L4 L4–L5 |
L3–L4 L4–L5 |
| Needle size | 25 G | 25 G | 22 G | 22 G | 27 G | 27 G | 22 G | 22 G | - | - | 25 G | 25 G | 25 G | 25 G |
| Infused volume (ml) | 1.5 | 1.5 | 2 | 4 | - | - | 2.2 | 2.2 | 3 | 3 | - | - | - | - |
| Position during procedure | Lateral on the operating side | Lateral on the operating side | Lateral, fracture side up | Lateral, fracture side up | Sitting | Sitting | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up | Lateral, fracture side up |
| Level of sensory block (max) | T10 | T10 | T8 | T6 | T7 | T6 | T6–T12 | T5–L3 | - | - | - | - | - | - |
| Sensory block onset (min) | - | - | - | - | - | - | - | - | 8 (4) | 6 (2) | - | - | - | - |
| Motor block onset (min) | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Duration sensory block (min) | 78.6 [60–160] | 125.5 [70–210] | - | - | - | - | - | - | 91 (32) | 113 (19) | 105 [100–200] | 120 [105–160] | 140 [110–160] | 133 [108–170] |
| Duration motor block (min) | - | - | - | - | - | - | - | - | - | - | 115 [100–125] | 120 [105–131] | 150 [110–160] | 123 [108–213] |
| Modified Bromage scale (0–3) | - | - | - | - | 2 | 3 | - | - | - | - | - | - | - | - |
| Type of fluid infused | RL | RL | RL | RL | RL | RL | HaS | HaS | NS | NS | HES | HES | HES | HES |
| Dose of infused fluid (mg/kg) | - | - | 8 | 8 | - | - | 8 | 8 | 5 | 5 | 5 | 5 | 5 | 5 |
| Total fluid administered (ml) | 500 | 500 | - | - | 500 | 500 | - | - | - | - | - | - | - | - |
| Patients with hypotensive events (%) | 14 | 76 | 10 | 90 | 16 | 88 | 25 | 75 | 59 | 92 | 53 | 47 | 83 | 81 |
Hyper hyperbaric, Hypo hypobaric, Iso isobaric, L low-dose subgroup, H high-dose subgroup, N/A not administered, G gauge, RL Ringer Lactate, HaS Hartmann’s solution, NS normal saline, HES hydroxyethyl starch 6%. Bromage motor blockade score: grade I, free movement of legs and feet; grade II, just able to flex knees with free movement of feet; grade III, unable to flex knees, but with free movement of feet; and grade IV, unable to move legs or feet. The fluids infused before spinal anesthesia are reported as either a standardized bolus (i.e., 500 ml for all the enrolled patients) or a weight-based bolus (5–8 ml/hg)