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PubMed1996

Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine.

This is a case report of an 18-month-old 10 kg child who presented for emergency repair of a recurrent diaphragmatic hernia with a history of craniofacial dystosis and was given a caudal block postoperatively with a combination of 4 ml of 0.5% bupivacaine and 2.5 micrograms.kg-1 buprenorphine made up to a total volume of 10 ml. An inadvertent dural puncture occurred resulting in total spinal block which was managed symptomatically. Block regression started one h later when the respiratory movements became noticeable. Eye opening and hand movements returned 3 h later. The patient's exposure to a large intrathecal dose of buprenorphine did not lead to prolonged respiratory depression. The possibility of a midbrain insult due to a sudden rise in intracranial pressure is also discussed.

Analgesia, Epidural↗
PubMed2004

Intrathecal meperidine decreases shivering during cesarean delivery under spinal anesthesia.

UNLABELLED: Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. We performed this prospective, double-blinded, and randomized study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the incidence and intensity of shivering after spinal anesthesia for cesarean delivery. Forty parturients scheduled for nonemergent cesarean delivery were enrolled in two groups. Spinal anesthesia consisted of hyperbaric bupivacaine (0.75%; 10.5 mg), morphine 0.15 mg, and, in the experimental group, meperidine (0.2 mg/kg) or, in the control group, normal saline. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was performed every minute for 10 min, every 3 min for 33 min, and then every 5 min until the sensory level receded to L4. Time to highest sensory level, maximum number of blocked segments, sensory and motor blockade regression, and systolic blood pressure showed no difference between groups. The incidence of shivering was less (P < 0.02) in the meperidine group, as was its intensity (P < 0.003). Intrathecal meperidine (0.2 mg/kg) is effective in reducing the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery. IMPLICATIONS: Previous studies have suggested that IV meperidine is helpful for treating intraoperative shivering. This study was undertaken to evaluate spinal meperidine and found that it decreases the incidence and intensity of shivering associated with spinal anesthesia for cesarean delivery.

Adult↗
PubMed1999

Addition of intrathecal midazolam to bupivacaine produces better post-operative analgesia without prolonging recovery.

OBJECTIVE: The administration of midazolam by centroneuraxis route has been shown to produce segmental antinociception. This midazolam analgesia was found to enhance the effects of local anesthetics given in combination epidurally without any adverse effects. The present study was designed to evaluate the post-operative analgesic effect of intrathecal midazolam-bupivacaine mixture in patients undergoing knee arthroscopy. METHODS: Thirty healthy patients scheduled for knee arthroscopy were divided into two groups to receive either midazolam-bupivacaine mixture (group M; n = 15) or bupivacaine alone (group B; n = 15) intrathecally. Level of sensory block, sedation score, assessment of pain using visual analogue score were recorded in both groups at regular time intervals. Time to block regression, recovery to ambulation and ability to void were recorded and noted before discharge. RESULTS: A significantly higher VAS score was seen in group B patients as compared to the score observed in group M patients before discharge (p<0.05). All patients received rescue analgesia in group B at a mean duration of 258 +/-46.8 minutes whereas only one patient in group M required supplemental analgesia within this period. Time to regression of sensory analgesia to L5-S1 level was longer in group M (267+/-67.38) as compared to group B (229.8+/-41.4) (p<0.05). Blood pressure, heart rate, oxygen saturation and sedation score showed no differences between the groups. Neither motor block nor time to void were prolonged with the addition of midazolam to bupivacaine. CONCLUSION: The results suggest that addition of midazolam to bupivacaine intrathecally provided better post-operative analgesia without any adverse effects.

Adjuvants, Anesthesia↗
PubMedDate not supplied

[Pediatric regional anesthesia: rational approaches and practical aspects].

Regional anesthesia in children is to be carried out with due consideration for anatomy, physiology (specifically, neurophysiology), pharmacology of local anesthetics, and detailed knowledge of pediatric protocols of numerous regional blockades. Age-specific differences in the pharmacokinetics of local anesthetics should be borne in mind when choosing safe doses and protocols. The pharmacokinetic factors may involve the risk of toxic reactions to local anesthetics. The protocols of central neuroaxial blockades in children are characterized by certain differences, concerning the indications, anatomic reference points, choice of special equipment, doses, and schemes of administration.

Age Factors↗
PubMed2004

Intrathecal fentanyl in spinal anesthesia for appendectomy.

OBJECTIVE: The authors assessed the effectiveness of the administration of fentanyl in spinal anesthesia for appendectomy. MATERIAL AND METHOD: Forty patients randomized double-blind, were recruited to receive either 4 ml of 0.5% hyperbaric bupivacaine + 20 mg of fentanyl (Group F) or 4 ml of 0.5% hyperbaric bupivacaine 0.5% + 0.4 ml normal saline (Group S). RESULTS: There were no significant differences in the highest analgesic level between the groups. The number of segments regressed at 60 min in Group F was statistically less than in Group S (0 vs. 2; P 0.002). Group F showed significantly lower median VNS pain scores than Group S (0 vs. 3; P 0.004). Time to first required postoperative analgesics in Group F was significantly higher than in Group S (13.6 vs. 6.3 h, P < 0.001). The incidence of shivering in Group F was significantly lower than Group S (35% vs. 70%; P 0.023). There were no significant differences in the incidence of nausea, vomiting, hypotension and urinary retention. No patient developed respiratory depression or PDPH. The patients' satisfaction of spinal anesthesia was 100% in Group F and 80% in Group S. CONCLUSION: Intrathecal 20 microg fentanyl significantly improved the quality of analgesia, it prolonged the duration of bupivacaine in spinal anesthesia and delayed the analgesics requirement in the early postoperative period. Shivering was less frequently found in the fentanyl group.

Adjuvants, Anesthesia↗
PubMedDate not supplied

Subarachnoid neostigmine does not affect blood pressure or heart rate during bupivacaine spinal anesthesia.

BACKGROUND AND OBJECTIVES: Intraspinal administration of neostigmine has been shown to prevent induction of hypotension in rats by bupivacaine spinal block, and thus to provide greater hemodynamic stability. This study was undertaken to determine whether subarachnoid neostigmine would prevent bupivacaine spinal anesthesia from causing hypotension or bradycardia in patients undergoing abdominal hysterectomy. METHODS: Of 40 patients scheduled for abdominal hysterectomy under spinal anesthesia, 20 were randomly assigned to each of two groups. The control group (CG) received 1.5 mL subarachnoid saline followed by 15 mg (3 mL) of hyperbaric bupivacaine 0.5%. The neostigmine group (NG) received 75 micrograms (1.5 mL) of subarachnoid neostigmine followed by 15 mg (3 mL) of hyperbaric bupivacaine 0.5%. No preload was given. Hypotension was treated with 4-mg intravenous boluses of ephedrine to keep blood pressure above 75% of the baseline value. The skin body temperature was measured with probes at the suprascapular region and at the foot. RESULTS: Spinal neostigmine (75 micrograms) failed to prevent bupivacaine-induced hypotension. There was no statistical difference in the incidence of brady-cardia between the groups (NG, 2/20; CG 1/20), although the bradycardia appeared to be qualitatively different, being somewhat delayed in the NG. Spinal neostigmine did not alter the onset or duration of sensory block and did not affect skin body temperature in either anesthetized or unanesthetized sites. The incidence of intraoperative nausea was 20% in the NG and 5% in the CG. CONCLUSION: A 75-micrograms subarachnoid neostigmine dose does not affect blood pressure or heart rate during bupivacaine spinal anesthesia.

Adult↗
PubMed1995

Cervical primary afferent input to vestibulospinal neurons projecting to the cervical dorsal horn: an anterograde and retrograde tracing study in the cat.

Vestibulospinal neurons in the caudal half of the medial and descending vestibular nuclei terminate in the cervical spinal cord, not only in the ventral horn and intermediate zone but also in the dorsal horn. The purpose of the present study was to examine whether the areas containing these vestibulospinal neurons are reached by cervical primary afferents. In one group of experiments, wheat germ agglutinin-horseradish peroxidase conjugate and horseradish peroxidase were pressure injected into spinal ganglia C2-C8 and revealed anterogradely labeled fibers and boutons in the caudal part (caudal to the dorsal cochlear nucleus) of the ipsilateral medial and descending vestibular nuclei. This projection was verified in experiments in which wheat germ agglutinin-horseradish peroxidase conjugate was microiontophoretically injected into the caudal half of either the medial or the descending vestibular nuclei and revealed retrogradely labeled cells only in ipsilateral spinal ganglia C2-C7, with a maximum of cells in C3. In another group of experiments, after microiontophoretic injections of Phaseolus vulgaris leucoagglutinin or Biocytin into either the medial or the descending vestibular nuclei, anterogradely labeled fibers and boutons were present in the cervical spinal cord, mainly bilaterally in the dorsal horn (laminae I-VI) but also, to a lesser extent, in the ventral horn and intermediate zone. The existence of a loop that relays cervical primary afferent information to vestibulospinal neurons projecting to the cervical spinal cord, in particular the dorsal horn, may have implications for vestibular control over local information processing in the cervical dorsal horn.

Afferent Pathways↗
PubMed1989

Effect of ruthenium red on responses mediated by activation of capsaicin-sensitive nerves of the rat urinary bladder.

(1) Topical administration of Ruthenium Red (10-100 microM in saline) to the serosal surface of the urinary bladder in urethane-anesthetized rats prevented the motor response of the urinary bladder to topical administration of capsaicin and protected the sensory fibers from capsaicin desensitization, but had no effect on the volume-evoked contractions (micturition reflex). At 1 mM increased bladder capacity and decreased amplitude of micturition contraction were observed. (2) At 100 microM, topical Ruthenium Red prevented the blood pressure rise produced by topical administration of capsaicin onto the bladder but did not affect the blood pressure rise produced by sudden bladder distension in spinal rats. (3) After intrathecal administration, Ruthenium Red (80-800 ng/rat) produced a long lasting inhibition of the micturition reflex in urethane-anesthetized rats, this effect being evident in both vehicle- or capsaicin- (50 mg/kg s.c. 4 days before) pretreated rats. At 800 ng/rat, intrathecal Ruthenium Red did not affect the blood pressure rise produced by topical administration of capsaicin onto the rat bladder nor that produced by bladder distension. (4) These findings provide further evidence that Ruthenium Red acts quite selectively as a "capsaicin antagonist" preventing both reflex and "efferent" responses activated by peripherally administered capsaicin. By contrast, sensory impulse generation by a natural stimulus such as bladder distension is apparently unaffected by Ruthenium Red. The marked inhibition of the micturition reflex observed after intrathecal administration of Ruthenium Red does probably not involve an interaction with primary afferents in the spinal cord.

Administration, Topical↗