COMPARISON OF EFFICACY OF BUPIVACAINE; HYPERBARIC AND HYPOBARIC SOLUTIONS FOR OPEN REDUCTION AND INTERNAL FIXATION FOR TIBIAL FRACTURE UNDER UNILATERAL SPINAL ANESTHESIA

Abstract

Background: Tibial fractures require effective anesthesia during surgery. While hypobaric bupivacaine has been used traditionally, hyperbaric solutions offer better unilateral block. Due to limited local data, this study was conducted to compare both in ORIF procedures. Objectives: To compare the outcome of hyperbaric versus hypobaric solutions for open reduction and internal fixation for tibial fracture under unilateral spinal anesthesia. Duration: Six months w.e.f 16-11-2023 to 15-05-2024 Methodology: After ethical approval, 100 patients meeting inclusion criteria were selected from Sir Ganga Ram Hospital, Lahore. Informed consent was obtained, and demographics recorded. Patients were randomly assigned to Group A (2 ml hyperbaric bupivacaine 0.75%) or Group B (3 ml hypobaric bupivacaine 0.5%). Anesthesia was administered by the researcher. Sensory block, recovery time, and surgery duration were recorded.  Results: The mean age of participants was 38.03 ± 14.07 years, with 67% male and 62% overweight/obese. Group A had a higher efficacy (94% vs. 78%, p = 0.021) and faster onset (7.24 ± 1.67 vs. 10.16 ± 1.19 minutes, p < 0.001) compared to Group B. Recovery time was longer in Group A (146.30 ± 14.88 vs. 129.28 ± 12.51 minutes, p < 0.001). Stratified analysis showed consistent outperformance by Group A, with significant differences in sensory block onset and recovery (p < 0.05). Conclusion: Hyperbaric bupivacaine demonstrated greater efficacy than hypobaric bupivacaine, with higher block success, faster onset, and longer duration. Though subgroup significance varied, overall results favor hyperbaric use for unilateral spinal anesthesia in tibial surgeries.