Evidence map›Paper›PMID 42099206›Full record

Observational studyKorean journal of anesthesiology2026

Success rate and block characteristics of L5-S1 spinal anesthesia with hypobaric bupivacaine in total hip and knee arthroplasty.

Iskandar Khalid, Wendy Wang, Rachel Chin, Seung Cheol Paul Kim, Madeline Marquis, Jayanta Chowdhury, Ki Jinn Chin

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Korean journal of anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Iskandar KhalidDepartment of Anesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, UKM, Kuala Lumpur, Malaysia.
Wendy WangTemerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Rachel ChinFaculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Seung Cheol Paul KimDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Madeline MarquisDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Jayanta ChowdhuryDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Ki Jinn ChinDepartment of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. kijinn.chin@uhn.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSpinal anesthesia in older patients can be technically challenging due to degenerative spinal disease. The L5-S1 interspace often remains accessible and is a useful fallback; however, it has been associated with higher rates of therapeutic failure due to inadequate block height. Injection of hypobaric local anesthetic may promote cranial intrathecal spread and address this limitation. We investigated this by evaluating the efficacy and block characteristics of low-dose hypobaric bupivacaine injected at the L5-S1 level in a prospective observational study.

methodsFifty-four patients undergoing elective total hip or knee arthroplasty received ultrasound-assisted spinal anesthesia at L5-S1 with 10 mg of 0.33% hypobaric bupivacaine. The primary outcome was surgical completion without conversion to general anesthesia, supplemental opioids, or local anesthetic infiltration. Secondary outcomes included adequate anesthesia for surgical incision, block pharmacodynamics, hemodynamic stability, adverse effects, patient satisfaction, and surgeon-perceived quality of anesthesia.

resultsSurgical completion without anesthetic supplementation was successful in 50 patients (92.6%, 95% CI [82.1-97.8]). Adequate anesthesia for surgical incision was achieved in 53 patients (98.2%, 95% CI [90.1-100]). Four patients required supplemental opioids: one for surgical incision, and three for surgical completion following prolonged injection-to-incision intervals (47-59 minutes) due to unanticipated delays in operating room readiness. No patients required conversion to general anesthesia. Full motor recovery occurred within 198 ± 53 minutes. Patient and surgeon satisfaction with quality of anesthesia was high.

conclusionsHypobaric 0.33% bupivacaine injected at L5-S1 may be a useful fallback option in lower-extremity arthroplasty if challenging spinal anatomy renders other interspaces inaccessible.

Indexed as

Anesthesia, SpinalAnesthetics, LocalArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBupivacaineAgedAged, 80 and overFemaleHumansMaleMiddle AgedProspective StudiesTreatment OutcomeUltrasonography, InterventionalAnesthetics, LocalBupivacaineAnesthesia, spinalAnesthetics, localArthroplasty, replacement, hipArthroplasty, replacement, kneeBupivacaineLumbosacral regionPatient outcome assessment

Identifiers

PMID42099206
PMCPMC13439151

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.