Hemodynamic effects of plain versus hyperbaric bupivacaine during spinal anesthesia for total knee arthroplasty: a randomized clinical trial
Authors' conclusion
In this superiority trial using 10 mg intrathecal bupivacaine for elective TKA, superiority of PB over HB for early hemodynamic stability was not demonstrated.
Study context
- Population
- Adults undergoing elective total knee arthroplasty under spinal anaesthesiaanalysed
- Participants
- 60 adults
- Comparison
- Plain vs hyperbaric bupivacaine, 2 mL of 0.5%, for spinal anesthesia (SA)
- Plain bupivacaine (PB)n = 30
- Hyperbaric bupivacaine (HB)n = 30reference
- Primary endpoint
- Maximal relative decrease in MAP from preoperative baseline
- Follow-up
- Within 1 hour
Methodological detailsprospective, double-blinded, single-centre, superiority
- Prospective
- Double-blinded
- Single-centre
- Superiority
Primary result
As reported in the abstract
Maximal relative decrease in MAP · first hour after SA
HB
33.1%
mean · SD 13.3
PB
33.1%
mean · SD 11.5
Secondary outcomes
Nadir MAP
Nadir mean arterial pressure (MAP)
- Similar between groups
MAP and heart rate trajectories (mixed-model)
- Significant effect of time; no significant group effect or group-by-time interaction
Safety
Nausea and vomiting
Original publication
Hemodynamic effects of plain versus hyperbaric bupivacaine during spinal anesthesia for total knee arthroplasty: a randomized clinical trial. Reg Anesth Pain Med. Published 31 March 2026. doi:10.
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