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Background: To compare proportion of the patients with attainment of sensory level T4, at 5 and 10 min supine, and after 10 min prone amongst patients receiving 22.5 mg bupivacaine with those receiving 30 mg. Methods: In this randomized clinical trial patients (n=60), undergoing percutaneous nephrolithotomy, were included. It was done to compare the achievement of sensory level T4 during PCNL after spinal anaesthesia with two doses of bupivacaine before and after positioning patients in prone position. Patients were grouped into: Group A (22.5 mg hyperbaric Bupivacaine 0.75%) versus Group B (30 mg hyperbaric Bupivacaine 0.75%) consisting 30 patients each. Spinal anaesthesia was performed while sitting. Sensory level was checked using icecube in mid-axillary line while patients were positioned supine and prone. Results: Number of patients with T4 level at 5 min and 10 min supine in Group B was much higher than in Group A (p<0.001). In comparison of attainment of T4 level in supine and after 10 min of prone position, more number of patients achieved the level after 10 minutes of prone position in contrast to Group A and it was statistically significant (p<0.001). Conclusion: Positioning in prone extends the sensory level of spinal anaesthesia to higher level (T4) when 22.5 mg of hyperbaric bupivacaine is used and hence reduced dose can be given efficiently and safely for the procedure. [ABSTRACT FROM AUTHOR]

Background: To compare variation in haemodynamics during percutaneous nephrolithotomy in spinal anaesthesia with two doses of hyperbaric bupivacaine (0.75%). Methods: In this randomized comparative study 60 patients, undergoing percutaneous nephrolithotomy, were included. It was done to compare the variation in haemodynamic parameters after spinal anaesthesia using two different doses of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A(n=30) (22.5 mg hyperbaric Bupivacaine 0.75%) and Group B (n=30)(30 mg hyperbaric Bupivacaine 0.75%). Spinal block was performed in sitting position. Hemodynamic measurements were carried out at different time points while patients were in supine and prone position. Results: Decrease in heart rate was significant in Group B than in Group A after 10 minutes of spinal block while in supine position (p<0.001) and the drop in heart rate was significant statistically in Group B when patients were turned to prone position (p<0.001). Systolic and diastolic blood pressures decreased in Group B at 5 and 10 minutes in supine position which further decreased following prone positioning and the decrease was highly significant statistically(p=<0.001). Conclusion: 22.5 mg of injection hyperbaric Bupivacaine is haemodynamically safer as compared to 30 mg of the same drug during spinal anaesthesia in percutaneous nephrolithotomy. [ABSTRACT FROM AUTHOR]