Comparision of Intrathecal 0.5% Hyperbaric and Isobaric Bupivacaine for Cesarean Section / 대한마취과학회지

BACKGROUND: Baricity differences between spinal anesthetic solutions are thought to produce differences in distribution of anesthetics within the subarachnoid space. We evaluated the influence of baricity of bupivacaine on the quality of the block and the incidence of side effects obtained following intrathecal injection of bupivacaine 8 mg with fentanyl 20 microgram. METHODS: Thirty healthy term parturients scheduled for a cesarean section under combined spinalepidural procedures were randomly allocated into Group I, hyperbaric bupivacaine (n = 15); or Group II, isobaric bupivacaine (n = 15). The dose of both groups was bupivacaine 8 mg combined with fentanyl 20 microgram. The maximum level of sensory blockade, time to reach T4 level and maximum level, time to get complete motor recovery and perioperative complications were assessed. RESULTS: Time to sensory block T4, motor block Bromage scale 3, complete resolution of motor block and sensory regression time to T10 was significantly delayed in Group II compared to Group I. Maximal block height, and time to maximal block had no significant differences between the two groups. There were no significant clinical advantages of one preparation over the other. CONCLUSIONS: The data from this study suggests that intrathecal injection of either hyperic or isobaric bupivacaine produces satisfactory anesthesia with similar side effects.

The Effect of Intrathecal Bupivacaine Mixed with Sufentanil for Labor Analgesia / 대한마취과학회지

BACKGROUND: The combination of a local anesthetic and an opioid has been shown to produce effective epidural labor analgesia. It was reported that the combination of intrathecal opioid and bupivacaine could produce labor analgesia with longer duration and less side effects. This study was done to evaluate the effect of intrathecal bupivacaine mixed with sufentanil for labor analgesia. METHODS: Eighty women requesting labor analgesia were randomly assigned to receive intrathecal 10 mcg of sufentanil (S group, n = 40) or 2.5 mg of bupivacaine plus 10 microgram of sufentanil (SB group, n = 40) diluted in a total volume of 2.2 ml with normal saline. The analgesia was performed using combined spinal-epidural technique in the lateral position. Visual analogue scales (VAS) for pain, sensory changes to cold, duration of analgesia, motor block, hypotension, fetal heart rate, pruritus, and other side effects were assessed for 30 minutes after intrathecal drug injection. RESULTS: There were no significant differences in the VAS pain scores and sensory levels at 5 minutes after intrathecal drug injection between groups. However, VAS pain scores were significantly lower and sensory levels higher in the SB group at 15 minutes and 30 minutes after intrathecal drug injection. The duration of analgesia provided by intrathecal sufentanil (n = 31) was 103.4 41.1 min, by intrathecal sufentanil plus bupivacaine (n = 29) 113.0 32.1 min (P = 0.30). Motor block assessed by a modified Bromage scale was significantly frequent in the SB group (P< 0.001). Not only adverse effects such as hypotension, fetal bradycardia, pruritus, and nausea, but also satisfaction scores were similar in both groups. CONCLUSIONS: The addition of bupivacaine to intrathecal sufentanil produced more frequent motor block and extensive sensory block, but better analgesia. However, duration of analgesia, side effects and satisfaction score did not change.

The Effects of Combined Spinal Epidural Anesthesia for Hip Surgery in the Elderly / 대한마취과학회지

BACKGROUND: With recently increase in geriatric population, hip surgery of the aged is increasing likewise as one of the major surgical procedures for orthopedic surgeons. It is the purpose of this paper to study the effects of combined spinal epidural anesthesia on blood pressure, heart rate, pulse oxygen saturation, level of blockade, postoperative pain control and complication in geriatric hip surgery. METHODS: Combined spinal epidural anesthesia was performed with a 27G Whitacre spinal needle through a 18G Weiss epidural needle in 30 patients undergoing elective hip surgery of geriatric patients. 0.5% heavy bupivacaine 2 ml (10 mg) was injected intrathecally. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Onset of sensory anesthesia and motor blockade were measured at frequent intervals. Blood pressure, heart rate and pulse oxygen saturation were checked in preoperative state, 1, 2, 3, 4, 5, 7, 9, 11, 13, 15 minute after injection, and then every 3 minute until the operation was finished. 0.125% bupivacaine 110 ml with morphine 3 mg was provided by Baxter infusor (Baxter Healthcare CO. Deerfield, USA) for postoperative pain control. RESULTS: All 30 patients had adequate anesthesia. Sensory block level was at least above T10 dermatome and motor blockade of lower extremity was Bromage 3 in all patients. Systolic blood pressure and diastolic blood pressure were significantly different (P<0.05) after 3 minutes compared to preoperative state, but any patient had no specific problem. Postoperative pain control was excellent with no significant complication. CONCLUSIONS: Combined spinal epidural anesthesia provided reliable anesthesia for hip surgery of geriatric patients without significant complication.

Methods for Differentiation of the CSF and Local Anesthetics during Combined Spinal Epidural Anesthesia: A case report / 대한마취과학회지

Combined spinal epidural block with use of the needle-through-needle technique has become increasingly more popular during recent years because it provides rapidity and density of spinal block, combined with the ability to extend the block and provide postoperative analgesia by use of the extradural catheter. However, the combined spinal epidural block has some disadvantages. Since the spinal needle makes a hole in the dura, the accidental migration of an extradural catheter into the dural opening made previously by the spinal needle is thought to be theoretical risk. We report a case during combined spinal epidural anesthesia for a total hip replacement in which the clear fluid in the epidural catheter was found and tested to confirm the nature of fluid and migration of catheter by the dextrostix test and the immunoelectrophoresis test(prealbumin test).

Effect of Single Epidural Saline on Spinal Sensory Blockade Level during Combined Spinal Epidural Anesthesia / 대한마취과학회지

BACKGROUND: Combined spinal epidural anesthesia (CSE) is used for obtaining adventages of both spinal and epidural anesthesia. But it might be suspected that epidural volume load affect spinal sensory blockade level during CSE. METHODS: Eighty patients undergoing lower abdominal and lower extremity operation were involved in our study. Subarachnoid block with 12mg of tetracaine was established in all patients. Four groups were studied. Group 1 (n=20), the control, received only spinal anesthesia. Group 2 (n=20), group 3 (n=20) and group 4 (n=20) received 10, 15 and 20 ml of epidural saline immediately after spinal anesthetic administration. Sensory blockade level was checked by pinprick test at 5, 10, 15, 20, 25, 30, 40, 60 and 90 minutes. Blood pressure, heart rate and incidence of complications such as hypotension, bradycardia, nausea and high block were measured. RESULTS: The sensory blockade level of groups 3 and 4 was higher than group 1 (p<0.05). Blood pressure and heart rate were not different compared with each other. The incidence of complications, except that higher block above T4 in group 4 was more than in group 1 (p<0.05), were not different when compared with each other. CONCLUSIONS: Epidural saline above 15 ml may affect sensory blockade level of spinal anesthesia during CSE.

The Effects of Combined Spinal Epidural Anesthesia on Subarachnoid Block for Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.

The Combined Spinal Epidural Anesthesia Using Meperidine and Lidocaine for Cesarean Section / 대한마취과학회지

BACKGROUND: To reduce the disadvantages with both epidural and spinal block, a combined spinal epidural(CSE) technique was introduced by Brownridge in 1981. The effect of the combined spinal-epidural block was compared with the spinal block for elective cesarean section. METHODS: Fifty healthy parturients were randomly divided into a spinal(n=20) group and a CSE(n=30) group. In the spinal group, 0.5 ml of 5% meperidine(25 mg) mixed with 40~50 mg of 5% hyperbaric lidocaine was injected into the subarachnoid space . In the CSE group, 0.5 ml of 5% meperidine also was injected into the subarachnoid space through a long 26-gauge Quincke needle, which was introduced through an 18-gauge Tuohy needle. An epidural catheter was then inserted and 1.5% lidocaine 7~9 ml was given. RESULTS: 1) The mean time interval from the end of drug injection to T4 sensory block was 3.6?1.0 min in the CSE block and 3.6?1.2 min in the spinal block. The mean level of peak sensory block was T3.3?0.6 in the CSE block and T3.5?0.5 in the spinal block. The time interval between the end of drug injection and Bromage scale 0 of the CSE block(62.1?27.9 min) was significantly (p<0.0001) shorter than the spinal block(102.1?24.0 min). Hypotension ocurred in 14 patients(47%) of the CSE block and 10 patients(50%) of the spinal block. The surgical analgesia was exellent or good in both groups. CONCLUSIONS: The CSE block using meperidine and hyperbaric lidocaine for cesarean section resulted in rapid onset, good surgical analgesia and rapid motor recovery. And incidence of hypotension of the both groups was not significantly different.