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At least 109 records · Page 6Linked to original sources
PubMed2002

Intrathecal ropivacaine in rabbits: pharmacodynamic and neurotoxicologic study.

BACKGROUND: Ropivacaine is available for spinal or intrathecal use in humans, although data on neurotoxicity after spinal injection are not yet available. The authors experimentally determined the relationship between doses of intrathecal ropivacaine and spinal effects and local neurotoxic effects. METHODS: Eighty rabbits equipped with an intrathecal lumbar catheter were studied. Sixty were randomly assigned to receive 0.2 ml of intrathecal solutions as a sole injection of: 0.2%, 0.75%, 1.0%, and 2.0% ropivacaine (doses from 0.4-4.0 mg; groups R0.2 to R2.0), 5.0% lidocaine (10 mg; group L), or 0.9% NaCl as control (group C). Twenty other rabbits received either repeated injections of 0.2 ml of 0.2% ropivacaine every 2 days during 2 weeks (total dose of 2.8 mg; group RINT); or a continuous intrathecal infusion of 0.2% ropivacaine at the rate of 1.8 ml/h over 45 min (2.7 mg; group RCONT). Injection rate was 30 s in all groups except Rcont. Time to onset, duration and extent of motor block, and variations of mean arterial blood pressure were recorded in all groups. Somatosensory evoked potentials were also recorded in group RCONT and RINT. Seven days after the last intrathecal injection spinal cord and nerves were sampled for histopathologic study. RESULTS: In groups R0.2 and RINT, the lowest dose of ropivacaine induced a clinically visible spinal block in only 50% of rabbits, but SEPs recorded in group RINT were decreased by 70% in the lumbar dermatome. Complete motor block was observed with doses greater than 1.5 mg of ropivacaine (group RCONT and R0.75 to R2.0). Onset time was shorter and duration of block increased as doses of ropivacaine increased. Significant hypotension was observed only with 4.0 mg of ropivacaine (concentration of 2.0%). Complete paralysis and hypotension were observed with 5.0% lidocaine. No neurologic clinical lesion was observed in rabbits receiving saline or ropivacaine within the 7 days after the last intrathecal injection, and histopathologic study revealed no sign of neurotoxicity in these groups. In contrast, intrathecal lidocaine induced clinical and histopathologic changes. CONCLUSION: Ropivacaine induced dose-dependent spinal anesthesia, and did not induce any neurotoxicologic lesion in this experimental animal model.

Amides↗
PubMed1984

Spinal 5-HT or NA uptake inhibition potentiates supraspinal morphine antinociception in rats.

Spinal injection of the specific uptake inhibitor of 5-hydroxytryptamine (5-HT), citalopram, or of noradrenaline (NA), desipramine, potentiated the antinociception following intracerebroventricular injection of morphine in rats tested on the hot plate. Combined spinal injection of citalopram and desipramine caused a synergistic potentiation. The unselective and less potent inhibitor of both 5-HT and NA uptake, amitriptyline, did not cause potentiation. The results support the suggested involvement of both 5-HT and NA pathways in supraspinal morphine antinociception.

Amitriptyline↗
PubMed2000

Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia.

PURPOSE: To compare unilateral and conventional bilateral bupivacaine spinal block in outpatients undergoing knee arthroscopy. METHODS: One hundred healthy, premedicated patients randomly received conventional bilateral (n = 50) or unilateral (n = 50) spinal anesthesia with 8 mg hyperbaric bupivacaine 0.5%. A lateral decubitus position after spinal injection was maintained in unilateral group for 15 min. Times from spinal injection to readiness for surgery, block resolution, and home discharge were recorded. RESULTS: Three patients in each group were excluded due to failed block. Readiness for surgery required 13 min (5 - 25 min) with bilateral and 16 min (15 - 30) with unilateral spinal block (P = 0.0005). Sensory and motor blocks on the operated limb were T9 (T12 - T2) with a Bromage score 0/1/2/3: 0/2/0/45 in the unilateral group and T7 (T12 - T1) with Bromage score 0/1/2/3: 4/1/6/36 with bilateral block(P = 0.026 and P = 0.016, respectively). Vasopressor was required only in five bilateral patients (P = 0.02). Two segment regression of sensory level and home discharge required 81+/-25 min and 281+/-83 min with bilateral block, and 99+/-28 min and 264+/-95 min with unilateral block (P = 0.002 and P = 0.90, respectively). CONCLUSION: Seeking unilateral distribution of spinal anesthesia provided more profound and longer lasting block in the operated limb, less cardiovascular effects, and similar home discharge compared with bilateral spinal anesthesia, with only a slight delay in preparation time.

Adult↗
PubMed2000

Warm or cold saline for volume preload before spinal anaesthesia for caesarean section?

In this study, we compared the effect of prophylactic administration of warm and cold saline against spinal anaesthesia induced hypotension in parturients undergoing elective caesarean section. One hundred and thirteen parturients with singleton pregnancies received an i.v. infusion of isotonic saline 20 mL x kg(- 1)during the 15 min before spinal injection followed by 10 mL x kg(- 1)during the 20 min after spinal injection. Fifty-seven patients were allocated to the warm saline group (37 degrees C) and 56 to the cold saline group (21 degrees C). Discomfort in the infusion arm was less in the warm saline group (P<0.01), whereas the incidence of shivering was similar in the two groups. Following induction of spinal anaesthesia, blood pressures were significantly higher in the cold saline infusion group compared to the warm saline group (P<0.05). However, the group mean difference in mean arterial pressure was only about 5 mmHg, and the amount of ephedrine administered and the incidence of clinical significant hypotension did not differ between groups. In conclusion, the temperature of the fluid used for i.v. preload and maintenance at caesarean section under spinal anaesthesia is not clinically important.

Journal Article↗
PubMed1985

Bladder function in spinal anaesthesia.

Spinal anaesthesia with bupivacaine (22.5 mg) or with a glucose-containing solution of bupivacaine (20 mg) or tetracaine (15 mg) was given to 21 patients allocated randomly to these three groups. A urodynamic study was performed by CO2 cystometry. It consisted of recording of first sensation of bladder filling, sensation of full bladder, strength of maximal detrusor contraction, bladder capacity and urethral pressure. At the same time, using a quantitative method for measuring muscle strength, the motor block was evaluated for three separate movements--hip flexion, knee extension and plantar flexion of the big toe. After the spinal injection, the micturition reflex was rapidly blocked. One minute after the injection, eight patients experienced no strong desire to void when the bladder was overfilled, and 5 min after the injection bladder paralysis was present in most patients. The length of time from spinal injection to complete recovery of detrusor strength was 7-8 h and did not differ significantly between the three groups. The level of analgesia lay at or caudal to L5 when the detrusor strength returned. On the average, sensibility (pin-prick) in the sacral segments returned simultaneously with or somewhat earlier than complete recovery of detrusor strength. The muscle strength in the lower limbs was fully restored 40-140 min, on average, before the detrusor strength had completely recovered. There was good correlation between the time of full restoration of hip flexion and detrusor strength in the bupivacaine groups. Urethral pressure was reduced by a mean of 48% and returned to normal either at the same time as or slightly before complete recovery of detrusor strength.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

High dose spinal anaesthesia with glucose free 0.5% bupivacaine 25 and 30 mg.

The purpose of this study was to investigate if a more intense and/or prolonged blockade could be obtained safely when a high-dose intrathecal plain bupivacaine was given. Thirty patients for elective surgery were included. Two groups of 15 patients, received 25 or 30 mg 0.5% bupivacaine (plain). The sensory and motor blockade was determined. Heart rate and respiratory frequency was monitored continuously, arterial blood pressure every 5 minutes. Peak expiratory flow (PEF) was performed before, and 45 min after the spinal injection. In group 25 mg the maximal spread of analgesia was to T3.7 +/- 0.9 (mean +/- s.e.mean) after 45 minutes, in group 30 mg T3.1 +/- 0.4 also after 45 min (NS). The maximal extent of analgesia was retained for a significantly longer period and the initial decline in extent of analgesia was significantly slower in the 30 mg group. No significant difference as to duration of motor blockade was found. Peak expiratory flow diminished significantly 45 min after the spinal injection in both groups, but no significant difference was found between the groups. The total duration of analgesia did not differ significantly between the groups. A significantly longer duration of maximal cephalad spread, and a slower initial regression, was found in the 30 mg group. No severe uncontrolled haemodynamic or respiratory side effects occurred.

Adult↗
PubMed2003

Improvement in postoperative pain relief by the addition of midazolam to an intrathecal injection of buprenorphine and bupivacaine.

BACKGROUND AND OBJECTIVE: Intrathecal injections of the benzodiazepine midazolam have been reported to cause antinociception in animals and pain relief in human beings, including the potentiation of opioid analgesia. This study compared the efficacy of the addition of midazolam to a mixture of buprenorphine and bupivacaine used for spinal anaesthesia. METHODS: The study was prospective, randomized, and observer blinded. It involved 60 patients (30 per group), ASA I and II, age 20-40 yr, undergoing minor and intermediate lower abdominal surgery under spinal anaesthesia. Patients were randomized into two groups: the control group received a spinal injection of hyperbaric bupivacaine (15 mg) plus buprenorphine (0.15 mg) and the experimental group received a spinal injection of the same two drugs and doses but supplemented with intrathecal midazolam (2 mg). RESULTS: The duration of postoperative analgesia in the control group was 9.24 +/- 2.57 h (mean +/- SEM), and 21.33 +/- 12.69 h in the midazolam treated group (P < 0.001). Patients treated with intrathecal midazolam had better pain relief judged by visual analogue score on coughing (P = 0.0013) and a nursing mobility score (P < 0.0001). Adverse effects were minor and their incidence was similar in both groups. CONCLUSIONS: We conclude that intrathecal midazolam 2 mg improves the quality and duration of postoperative pain relief afforded by intrathecal buprenorphine and bupivacaine.

Abdomen↗
PubMed2002

Spinal epidural abscess after corticosteroid injections.

Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.

Adrenal Cortex Hormones↗
PubMed2005

Dexmedetomidine prolongs spinal anaesthesia induced by levobupivacaine 0.5% in guinea-pigs.

Alpha-2 adrenoceptor agonists have been used in association with local anaesthetic to increase the duration of spinal anaesthesia. Intrathecal administration of clonidine prolonged motor blockade induced by local anaesthetic. Since the affinity of dexmedetomidine (DEX) to alpha-2 adrenoceptors is eight-times greater than clonidine, it is expected that DEX could be advantageous in clinical anaesthesia. We investigated the duration of motor nerve block induced by spinal injection of 0.5% levobupivacaine (LVB) associated with intrathecal or intraperitoneal administration of DEX. Seventy-two guinea-pigs were randomly divided in 12 groups, which were all treated with intrathecal injection of 50 microL of LVB. DEX was injected intrathecally with LVB in 6 groups or injected intraperitoneally after LVB in another 6 groups. Intrathecal DEX (0.1, 0.2 and 0.4 microg) increased the LVB-induced motor anaesthesia from 48 (41-66) min to 84.5 (52-91) min (P < 0.05), 101.5 (83-115) min (P < 0.05) and 105 (97-114) min (P < 0.05), respectively. Similarly, intraperitoneal DEX (20 and 40 microg kg(-1)) increased the motor blockade from 48.5 (33-59) min to 88 (71-114) min (P < 0.05) and 114.5 (103-156) min (P < 0.05), respectively. Pre-treatment with yohimbine reduced the duration of motor block from 101.5 (83-115) to 76.5 (68-86) min (P < 0.05) or from 114.5 (103-156) to 90 (83-93) min (P < 0.05) when DEX was administered by the intrathecal or intraperitoneal routes. Motor block induced by spinal injection of LVB was prolonged by intrathecal and systemic administration of DEX, which was partially dependent on activation of alpha-2 adrenoceptors.

Adrenergic alpha-2 Receptor Agonists↗
PubMed2003

Isobaric versus hypobaric spinal bupivacaine for total hip arthroplasty in the lateral position.

UNLABELLED: Total hip arthroplasty (THA) is frequently performed under spinal anesthesia using either isobaric or hypobaric anesthetic solution. However, these two solutions have never been compared under similar surgical conditions. In the present study, we compared the anesthetic and hemodynamic effects of isobaric and hypobaric bupivacaine in 40 ASA physical status I-II patients undergoing THA in the lateral decubitus position under spinal anesthesia. With operative side up, patients randomly received, in a double-blinded manner, a spinal injection of 3.5 mL (17.5 mg) of plain bupivacaine mixed with either 1.5 mL of normal saline (isobaric group) or 1.5 mL of distilled water (hypobaric group). Sensory level and degree of motor block were evaluated on the nondependent and dependent sides until regression to L2 and total motor recovery. Hemodynamic changes during the first 45 min after spinal injection, and the time between spinal administration and first analgesic for a pain score >3 (on a 0-10 scale) were noted. Demographic characteristics of both groups were comparable. Upper sensory level and maximal degree of motor block were comparable between the operative and nonoperative sides in each group and between corresponding sides in both groups. Compared with the isobaric group, in the hypobaric group there was a prolonged time to sensory regression to L2 on the operative side (287 +/- 51 versus 242 +/- 36 min, P < 0.004) and a prolonged time to first analgesic (290 +/- 46 versus 237 +/- 39 min, P < 0.001). No difference in quality of motor block was noted at the end of surgery. Hemodynamic changes were comparable. We conclude that for THA in the lateral position, spinal hypobaric bupivacaine seems to be superior to isobaric in that it prolongs the sensory block on the operative side and delays the use of analgesics after surgery without further compromising hemodynamic stability. IMPLICATIONS: For total hip arthroplasty in the lateral position, spinal hypobaric bupivacaine compared with isobaric prolonged sensory block at the operative side and delayed the time to first analgesic.

Anesthesia, Spinal↗
PubMed2002

Postural stability following ambulatory regional analgesia for labor.

BACKGROUND: The safety of mobilization following low-dose regional analgesia in parturients remains controversial. Previous studies have demonstrated preserved balance function despite clinically elicited sensory deficits. The aim of this study was to use the Balance Master 6.1, a device capable of real-time analysis of ambulation, to score the performance of basic maneuvers following initiation of low-dose combined spinal-epidural analgesia in laboring women compared with pregnant and nonpregnant controls. METHODS: Using the Balance Master, balance function during the performance of several simple tasks, including walking and standing up from a sitting position, was evaluated in a prospective, controlled, observational study with 50 laboring women after combined spinal-epidural analgesia compared with 50 pregnant and 50 nonpregnant controls. RESULTS: Nonpregnant women scored significantly better results in 6 of the 13 measured balance function parameters compared with both the combined spinal-epidural and pregnant control groups. Compared with the nonpregnant subjects, the pregnant groups generated less force standing up from the sitting position (P < 0.0001), walked more slowly (P = 0.0067), and took shorter steps (P < 0.0001). They also took longer to step up onto and over a 20-cm-high obstacle (P < 0.0001), and they generated less force while stepping up. Initial spinal analgesia in laboring women did not significantly affect performance in comparison to the pregnant controls. Thirty-four percent of women in the combined spinal-epidural group required supplemental epidural analgesia following the initial spinal injection (n = 17) before testing; they had significantly impaired balance function in four tests compared with those receiving a spinal injection only (n = 33). CONCLUSIONS: Being pregnant at term significantly affects balance function, although initial low-dose spinal-epidural analgesia does not impair function further. Subsequent supplemental epidural analgesia may have a detrimental effect on balance, but properly designed studies are awaited to confirm this. This study supports the practice of allowing laboring women with initial low-dose spinal-epidural analgesia to ambulate, but indicates that further studies need to be conducted on the effects of subsequent epidural supplementation.

Adult↗
PubMedDate not supplied

Level of injection in spinal anesthesia: effect on sensory anesthetic level.

BACKGROUND AND OBJECTIVES: A prospective, randomized study was performed to investigate the influence of the level of injection on sensory anesthesia when bupivacaine 0.5% adjusted to 37.0 C was used. METHODS: Three milliliters of plain bupivacaine 0.5% were injected at either the L2-3 interspace or the L4-5 interspace. There were 10 patients in each group. The patients were kept sitting for 2 minutes after injection. RESULTS: No significant difference in maximal level of sensory anesthesia was found (p = 0.123). CONCLUSION: These preliminary results indicate that if a higher level of injection is more suitable for anatomic reasons, it can safely be used without the risk of a much higher level of sensory blockade.

Aged↗