Hyperbaric prilocaine vs. hyperbaric bupivacaine for spinal anaesthesia in women undergoing elective caesarean section: a comparative randomised double-blind study.

Hyperbaric bupivacaine spinal anaesthesia remains the gold standard for elective caesarean section, but the resultant clinical effects can be unpredictable. Hyperbaric prilocaine induces shorter motor block but has not previously been studied in the obstetric spinal anaesthesia setting. We aimed to compare duration of motor block after spinal anaesthesia with prilocaine or bupivacaine during elective caesarean section. In this prospective randomised, double-blind study, women with uncomplicated pregnancy undergoing elective caesarean section were eligible for inclusion. Exclusion criteria included: patients aged < 18 years; height < 155 cm or > 175 cm; a desire to breastfeed; or a contra-indication to spinal anaesthesia. Patients were randomly allocated to two groups: the prilocaine group underwent spinal anaesthesia with 60 mg intrathecal prilocaine; and the bupivacaine group received 12.5 mg intrathecal heavy bupivacaine. Both 2.5 µg sufentanil and 100 µg morphine were added to the local anaesthetic agent in both groups. The primary outcome was duration of motor block, which was assessed every 15 min after arriving in the post-anaesthetic care unit. Maternal haemodynamics, APGAR scores, pain scores, patient satisfaction and side-effects were recorded. Fifty patients were included, with 25 randomly allocated to each group. Median (IQR [range]) motor block duration was significantly shorter in the prilocaine group, 158 (125-188 [95-249]) vs. 220 (189-250 [89-302]) min, p < 0.001. Median length of stay in the post-anaesthetic care unit was significantly shorter in the prilocaine group, 135 (120-180 [120-230]) vs. 180 (150-195 [120-240]) min, p = 0.009. There was no difference between groups for: maternal intra-operative hypotension; APGAR score; umbilical cord blood pH; maternal postoperative pain; and patients' or obstetricians' satisfaction. We conclude that hyperbaric prilocaine induces a shorter and more reliable motor block than hyperbaric bupivacaine for women with uncomplicated pregnancy undergoing elective caesarean section.

Spinal anaesthesia in neonates and infants: what about the cerebral oxygen saturation?

BACKGROUND: Spinal Anaesthesia (SA) has been firmly established as an efficient and safe technique, with minimal cardio-respiratory disturbance when administered in the neonatal period. Our objective was to assess the haemodynamic consequences of SA in infants, particularly its impact on cerebral perfusion using near-infrared spectroscopy (NIRS)-based cerebral oximetry (rSco2). METHODS: All infants up to 60 weeks' postmenstrual age, whether formerly preterm or not, and undergoing spinal anaesthesia, were enrolled. Haemodynamic data records, rSco2 and mean arterial blood pressure (MAP), were prospectively collected before SA (T0) and every five min for 30 min (T30) after the puncture. Compared with baseline measures, any changes of > 10% in rSco2 and of > 20% in MAP were considered clinically significant. Relative variations of data between T0 and T30 were analysed. RESULTS: Data of 103 infants were analysed. The mean relative changes in rSco2 were -2.25% (97.5% CI [-3.97; -0.5]) at T15, and 0.11% (97.5% CI [-1.67; 1.90]) at T30. No significant variation of rSco2 was recorded. The mean changes in MAP were respectively -13.94% (97.5% CI [-17.74; -10.14]) at T15 and -20.27% (97.5% CI [-24,25; -16.29]) at T30. MAP decrease was statistically and clinically significant 30 min after SA. No correlation between changes in MAP and rSco2 was found. The subgroup analysis did not reveal any effect of added intrathecal clonidine or preterm birth history on these results. CONCLUSIONS: In neonate and infants, SA did not cause clinically significant variation in cerebral oxygen saturation. Despite a significant decrease in MAP, cerebral auto-regulation seems to remain effective in neonates and not altered by spinal anaesthesia.

Cerebrospinal fluid volume in neonates undergoing spinal anaesthesia: a descriptive magnetic resonance imaging study.

BACKGROUND: Spinal anaesthesia (SA) reduces the risk of postoperative apnoea after general anaesthesia in neonates. In 30% of patients, however, the duration of anaesthesia provided does not allow completion of surgery. When compared with term infants, formerly preterm neonates experience a shorter duration of anaesthesia after SA. A difference in the cerebrospinal fluid (CSF) volume between those two populations could explain this difference, but this has never been investigated. The study was designed to evaluate the relationship between the spinal CSF volume and patient characteristics in neonates. METHODS: Sixty-seven neonates, aged 30-60 weeks postconception, were included in this study. Their spinal CSF volumes were calculated using magnetic resonance imaging, and these volumes were plotted individually against sex, term at birth, birth weight, current gestational age, civil age, and weight. Correlations between CSF volume and these variables were investigated. RESULTS: Fifty-four neonates completed the study. The CSF volume was found to be closely and linearly correlated with weight and postconceptional age. The relationship between spinal CSF volume and weight can be described as follows: CSF volume (ml)=1.94 weight (kg)+0.13. The CSF volume was not correlated with sex, weight, or term at birth, nor with civil age. CONCLUSIONS: The amount of spinal CSF in neonates can be estimated as 2 ml kg(-1) in both term and formerly preterm neonates. A difference in the CSF volume between them does not provide an explanation for a shorter duration of SA in the latter. Our findings reinforce weight-adjusted dosage of SA in neonates.

[Chronic pain and regional anesthesia in children]. / Douleurs chroniques et anesthésie locorégionale chez l'enfant.

Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety.

[Cerebral near-infrared spectroscopy (NIRS) in paediatric anaesthesia]. / L'oxymétrie cérébrale transcutanée en anesthésie pédiatrique.

Cerebral oximetry allows continuous real-time and non-invasive monitoring of cerebral oxygen saturation (cSO(2)), by measuring oxyhaemoglobin and deoxyhaemoglobin near infrared light absorption, similarly to pulse oximetry. cSO(2) measurement predominantly reflects brain venous compartment, and is correlated with jugular venous saturation. As jugular venous saturation, cSO(2) must therefore be interpreted as a measure of balance between transport and consumption of O(2) in the brain. Cerebral oximetry should be used as a trend monitoring, because its accuracy is insufficient to be considered as reliable measure of absolute value of ScO(2). In adult, correction of intraoperative cerebral desaturation reduces hospital stay, heavy morbidity and mortality, and serious postoperative neurocognitive impairment after cardiac and major abdominal surgery. In children, the occurrence of intra- and postoperative cerebral desaturations during congenital heart surgery is associated with increased neurological morbi-mortality. Cerebral oximetry could be a useful monitoring during anaesthesia of (ex) preterm neonates, due to the risk of impaired cerebral blood flow autoregulation in these patients.

[Regional anesthesia for postoperative analgesia at home in children]. / Place de l'anesthésie locorégionale dans l'analgésie postopératoire à domicile chez l'enfant.

Hospitalization at home has known for the past few years a growing interest in care of patients. It has shown its advantages in children in terms of reducing the stress of parental separation, postoperative infections and the cost of hospitalization. But, pain remains the most common complaint in the postoperative follow-up of patients. As in adults, regional anesthesia has also shown interest in children in terms of morphine consumption and quality of postoperative analgesia. However, the use of single shot regional anesthesia seems to induce an exacerbation of pain upon returning home. For management of prolonged postoperative pain at home, continuous peripheral nerve blocks are then presented as the best options. This type of analgesia is mainly reserved for major orthopedic surgery in children. The quality of analgesia obtained in different pediatric studies is excellent with a low rate of adverse events. L-enantiomer local anesthetics are predominantly used at low concentrations for the systemic safety provided. The use of elastomeric disposable pumps for LA infusion allows early and easy ambulation with a simplified management, bringing great satisfaction to parents and children.

[Epidemiologic picture of one-year-pediatric anesthesia in France]. / Photographie épidémiologique d'une année d'anesthésie pédiatrique en France.

INTRODUCTION: Nowadays, the epidemiological data on French pediatric anesthesia is limited. The purpose of this study was to perform an "epidemiological picture" of this activity. MATERIAL AND METHOD: From the national Program Information System Medicalization, we have identified the institutions of France performing more than 50 anesthesia by year in children under 15 years in 2008 and noted the demographic data, types of institutions, hospital stay and surgeries. RESULTS: Seven hundred and eighty-nine thousands and two hundred anesthetic procedures have performed during 648,018 hospital stays in 929 institutions. A percentage of 68.4% of children were between 3 and 15 years old, 26.7% between 1 and 3 years, 4.1% between 1 year and 1 month and 0.8% less than one month, including 62% of boys and 38% of girls. A percentage of 53.6% of hospital stays were realized in private institutions, 20.9% in University Hospitals (UH), and 20.4% in General hospitals (GH), mainly in day-case surgery (60%), 15.2% in stay of 24h and 24.8% in full hospital stay (FHS). The main surgeries were ENT (29%), digestive (21%), orthopedic (14%), urology (12%) and plastics (9%). Children less than 1 year old were managed by University Hospital and during FHS. Older children were managed in private institution and during day-case surgery. CONCLUSION: Over 50% of stays with anesthesia were performed in private institution and during day-case surgery. Controversially, the management of children younger than 1 year was mainly in University Hospital.

[Peripheral nerve blocks of the face in children]. / Les blocs nerveux périphériques de la face chez l'enfant.

The sensory innervation of the face is provided by the three major nerves, emerging from trigeminal nerve: the ophthalmic, maxillary and mandibular nerve. Nerve blocks of the face or head are not widely used in practice in France. However, regional anaesthesia has shown its value in terms of quality of analgesia and perioperative opioid economy in children and adults. Facial peripheral nerve blocks are divided into two categories: superficial trigeminal nerve blocks and deeper blocks such as the mandibular or suprazygomatic maxillary block. The performance of these blocks is simple provided the usual safety rules are followed. As for other peripheral nerve blocks, ultrasound guidance has shown its interest for the realization of facial nerve blocks to identify anatomical structure and to locate the spread of the injected local anaesthetic.

Intraoperative use of transoesophageal Doppler to predict response to volume expansion in infants and neonates.

BACKGROUND: Volume expansion (VE) in neonates or infants during volatile anaesthesia may lead to fluid overload if inappropriate. Transoesophageal Doppler (TED), a non-invasive cardiac output monitoring technique, can provide a comprehensive estimation of the volaemic status. We evaluated whether intraoperative TED-derived parameters can predict volume responsiveness. METHODS: Neonates and infants under general anaesthesia without myocardial dysfunction were prospectively included when the attending anaesthetist, blinded to TED measurements, decided to provide VE based on clinical appreciation and standard monitoring data. Standard and TED-derived data were recorded before and after VE. After VE, patients were classified as responders and non-responders, if their indexed stroke volume (iSV) increased by more than 15% or not, respectively. The attending anaesthetist assessment of VE responsiveness was recorded at the end of VE. RESULTS: Fifty patients aged 42 (4) post-conceptional weeks were included, among which 26 (52%) were responders. Baseline iSV was the only parameter associated with VE responsiveness. Baseline iSV was fairly correlated with VE-induced changes in iSV (ρ=-0.64) and was associated with an area under the receiver operating characteristic curve of 0.90 (0.80, 0.99). Using a cut-off of 25 ml m(-2), baseline iSV predicted volume responsiveness with a sensitivity of 92% and a specificity of 83%. Attending anaesthetists' assessment of VE effectiveness agreed only moderately with TED measurements of iSV changes. CONCLUSIONS: TED-derived iSV measurement during volatile anaesthesia is useful to predict and follow VE responsiveness in neonates and infants without myocardial dysfunction.

Population pharmacokinetics of nalbuphine after surgery in children.

BACKGROUND: Nalbuphine is an opioid analgesic agent widely used for control of mild-to-severe pain. However, limited data are available on the pharmacokinetics of this drug in children. The aim of this study was to characterize the population pharmacokinetics of nalbuphine in patients with ages ranging from 1 to 11 yr and to identify patient characteristics partially explaining inter-individual variability in nalbuphine pharmacokinetic parameters. METHODS: Twenty-two children were included in this study. They received nalbuphine after surgery by continuous infusion (loading dose, 0.2 mg kg(-1) over 10 min followed by continuous infusion of 0.8 mg kg(-1) over 24 h). If pain relief was not adequate, 0.1 mg kg(-1) bolus doses were allowed in 10 min. Eleven blood samples were collected per patient. The data were analysed by non-linear mixed-effect modelling with the use of a two-compartment structural model. RESULTS: Twenty patients completed the study. In the final model, the parameter values were standardized for a body weight of 70 kg using an allometric model. Population parameter estimates were: clearance 130 litre h(-1) 70 kg(-1), inter-compartment clearance 75.6 litre h(-1) 70 kg(-1), central volume of distribution 210 litre 70 kg(-1), and peripheral volume of distribution 151 litre 70 kg(-1). In the children of this study, total clearance expressed in litre h(-1) kg(-1) decreased significantly with increasing age and the elimination half-life significantly increased. CONCLUSIONS: The allometric power model developed in this study best reflected the data and may be useful for dose adjustment.

[Comparison of saline, air, and a mixture oxygen-nitrous oxide for endotracheal cuff tracheal tube inflation in children? A prospective randomized trial]. / Comparaison de sérum salé, d'air et d'un mélange oxygène-protoxyde d'azote pour le remplissage des ballonnets de sondes d'intubation chez l'enfant? Étude prospective randomisée.

OBJECTIVE: The purpose of the present study was to compare how many inflate and deflate are necessary to maintain the endotracheal tube cuff pressure between 15 and 35 cm H2O by using air, O2-N2O mix or saline solution. STUDY DESIGN: Randomized and prospective study. PATIENTS AND METHODS: Ninety children from 1 month to 15 years of age were included in the study. All patients were ventilated with O250%-N2O50%. Subsequently, the patients were divided in three groups: (1) Group 1: patients with air inflated cuffs; (2) Group 2: patients with O2-N2O mix inflated cuffs; (3) Group 3: patients with saline solution inflated cuffs. In all groups cuffs were inflated to reach an intracuff pressure of 20 cm H2O. The cuff pressure was then monitored every 10 minutes and adjusted to be between 15 and 35 cm H2O. Laryngeal and tracheal symptoms were noted in the recovery room. RESULTS: The three groups of patients were similar for age, weight, and sex. The length of surgery was significantly longer in Group 3. The deflate rate was higher in Group 1 (60%) than in Group 2 (10%) or 3 (3.3%) (p<0.0001). The inflate rate was higher in Group 2 (76.6%) than in Group 1 or 3 (both 3.3%) (p<0.0001). Side effects were comparable in the three groups of patients. CONCLUSION: Using air or O2-N2O mix to inflate cuffs is not reliable. SSI helps to maintain a more stable cuff pressure but monitoring is difficult and sometimes contraindicated by tracheal tubes producers. Inflating cuffs with air and regularly monitoring pressure is the most reliable and easiest technique.

[Continuous epidural block versus continuous psoas compartment block for postoperative analgesia after major hip or femoral surgery in children: a prospective comparative randomized study]. / Analgésie péridurale continue versus bloc continu du compartiment psoas pour l'analgésie postopératoire après chirurgie majeure du bassin ou du fémur chez l'enfant : étude prospective comparative randomisée.

BACKGROUND: Intravenous opioids and/or continuous epidural block (CEB) are used for postoperative analgesia after hip and/or femoral shaft surgery but adverse effects limit their use in children. A continuous psoas compartment block (CPCB), effective technique in adults can be an alternative. In this randomized comparative study, we wanted to evaluate CEB and CPCB in children after major hip surgery in terms of adverse events, pain relief and ropivacaine plasma concentrations. METHODS: After ethical committee and parents' approval, 40 children scheduled for hip surgery were included and randomly allocated to receive CPCB or CEB. After general anaesthesia induction, 0.5 mL/kg of 0.375% ropivacaine were injected via the epidural or lumbar plexus catheter. After surgery, 0.1 ml/kg per hour (group CPCB) or 0.2 ml/kg per hour (group CEB) of 0.2% ropivacaine was infused for 48h. Post-operative pain was evaluated using VAS or CHIPPS scores values at h1, h6, h12, h18, h24, h36 and h48, as well as doses of first line (paracetamol 15 mg/kg/6h) or second line rescue analgesia (0.2mg/kg intravenous nalbuphine), if pain score remained high after 30 mm. niflumic acid was systematically used. Adverse events were noted as well as parents' satisfaction at 48h. Ropivacaine plasma concentrations were measured four times up to 48h (h1, h6, h24 and h48) by high performance gas chromatography. RESULTS: Forty children 1 to 12 years old (CPCB=20, CEB=20) were included. The demographic data were equivalent in both groups. Postoperative analgesia was excellent for both continuous block techniques during the whole studied period. Doses of rescue analgesics were comparable in both groups at the end of the 48h. Number of children who had at least one side effect is significantly higher in CEB group. Furthermore, the number of local anaesthetic premature stops was significantly more frequent in this group. Median values of ropivacaine plasma level in CEB group were significantly higher than CPCB group at h6 and h24. Ten parents in the CEB group and 15 in CPCB group were satisfied. CONCLUSION: Continuous psoas compartment block is an effective technique of postoperative analgesia after major hip or femoral surgery in children. It equally manages postoperative pain with significantly less adverse event and decreased ropivacaine doses and plasma concentration than CEB.

[Interest of ultrasonographic guidance in paediatric regional anaesthesia]. / Intérêt de l'échographie en ALR pédiatrique.

The use of ultrasonographic guidance for regional anaesthesia has known recently a big interest in children in recent years. The linear ultrasound probes with a 25 mm active surface area (or probes with 38 mm active surface area in older children), with high sound frequencies in the range 8-14 MHz, allow a good compromise between excellent resolution for superficial structure and good penetration depths. In children, the easiest ultrasound guided blocks are axillar blocks, femoral blocks, fascia iliaca compartment blocks, ilio-inguinal blocks and para-umbilical blocks, caudal blocks. They permit a safe and easy learning curve of these techniques. The main advantage of ultrasound guided regional anaesthesia is the visualization of different anatomical structures and the approximate localization of the tip of needle. The other advantages for ultrasound guided peripheral nerve blocks in children are: faster onset time of sensory and motor block, longer duration of sensory blockade, increase of blockade quality and reduction of local anesthetic injection. The use of ultrasonographic guidance for central block allows to visualize different structures as well as spine and his content. Spinous process, ligament flavum, dura mater, conus medullaris and cerebrospinal fluid are identifiable, and give some information on spine, epidural space and the depth between epidural space and skin. At last, in caudal block, ultrasounds permit to evaluate the anatomy of caudal epidural space, especially the relation of the sacral hiatus to the dural sac and the search of occult spinal dysraphism. Benefit of this technique is the visualization of targeted nerves or spaces and the spread of injected local anaesthetic.

Population pharmacokinetics of the two enantiomers of tramadol and O-demethyl tramadol after surgery in children.

BACKGROUND: Few data are available on the stereoselective pharmacokinetics of tramadol in children. The aim of this study was to develop a population pharmacokinetic model for the (+)- and (-)-enantiomers of tramadol and its O-demethyl tramadol metabolite (M1) in children. METHODS: Twenty-five children (1-8 yr) were included in this study. Tramadol was administered after surgery by continuous infusion (loading dose, 2 mg kg(-1) i.v. over 10 min followed by continuous infusion of 8 mg kg(-1) over 24 h). If pain relief was inadequate, additional 1 mg kg(-1) i.v. bolus doses of tramadol were given over 10 min. A two-compartment structural model was used with NONMEM. RESULTS: For both enantiomers of tramadol, weight was the only patient characteristic parameter showing significant covariate effects on clearance (CL). CL increased by 5.7-6.1 litre h(-1) between 8-12 and 13-16 kg, and by 2.4-3.3 litre h(-1) between 13-16 and 17-33 kg. The rate constants associated with the metabolite elimination [0.144 h(-1), (+)-M1 and 0.18 h(-1), (-)-M1] were smaller than the elimination rate constants of the parent drugs [0.243 h(-1), (+)-tramadol and 0.241 h(-1), (-)-tramadol], suggesting that the metabolite disposition was rate-limited by its elimination. The presence of two subpopulations of patients was suspected on the basis of the observed bimodal distributions of the AUC(M1)/AUC(tramadol) ratios. CONCLUSIONS: The results of this study combine relationships between tramadol CL and patient covariates that may be useful for dose adjustment. Polymorphism is likely to contribute to the interpatient variability observed in the AUC M1/AUC tramadol ratios.

Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study.

BACKGROUND: Pain on injection limits the use of propofol in children. The combination of lidocaine and propofol is widely used to reduce pain. A new solvent [medium-chain triglyceride (mct)/long-chain triglyceride (lct)] has been advocated to be less painful than standard (lct) propofol in adults, but no information is available of its usefulness in pre-school children. We designed a prospective, randomized, double-blinded, placebo-controlled study to assess injection pain with two different propofol emulsions, each given with or without lidocaine in children <7 yr. METHODS: A total of 160 ASA I-III children were randomly assigned to receive lct-propofol or mct/lct-propofol, 5 mg kg(-1), with lidocaine 10 mg ml(-1) or saline. The site and size of venous cannulation and restlessness before injection were recorded in each patient. A pain score graded 0-6 was established based on spontaneous verbal and motor reaction during injection, each graded 0-3. Kruskall-Wallis and Mann-Whitney tests were used for statistical analysis. RESULTS: Median pain scores decreased in all groups compared with lct-propofol-saline (P<0.001) and were least in the lct/mct-propofol-lidocaine group (P<0.001). Painless injection (score, 0-2) occurred in 92.5% of patients in the mct/lct-propofol-lidocaine group compared with 41-77% in the others (P<0.001). CONCLUSIONS: Mct/lct-propofol caused significantly less pain than lct-propofol in preschool children. Mixing of lidocaine with mct/lct-propofol resulted in a further significant decrease, virtually eliminating the pain on injection.

[Perioperative analgesia with continuous peripheral nerve blocks in children]. / Analgésie périopératoire par bloc nerveux périphérique continu chez l'enfant.

Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain.

Intrathecal bupivacaine protects against extension of lesions in an acute contusive spinal cord injury model.

BACKGROUND AND OBJECTIVE: We recently demonstrated that intrathecal bupivacaine before or after acute photochemical spinal injury improved functional outcome in rats. However, the closest model to spinal trauma is the contusive weight-drop method. The aim of this study was to evaluate functional, electrophysiological and anatomical consequences of a contusive spinal-cord lesion in rats with or without an intrathecal injection of bupivacaine. METHODS: Fifteen minutes before a contusive spinal lesion, 18 rats received intrathecally either 0.5% bupivacaine (Group T) or saline (Group C). During an 18-days period, motor and sensory functions were evaluated, and bladder voiding dysfunction was noted. Somatosensory evoked potential testings were performed at day 18. Then, the intact spinal cord area at the epicentre of the lesion and the extent of the lesion were measured. RESULTS: Motor deficit was less and inclined-plane stability was better in treated animals at all times, the scores were statistically different from day 7. There were no differences concerning the sensory test. Despite no significant difference, there were less spinal bladders in the T group from day 7. Somatosensory evoked potential latencies were longer in T group, but only the first negative component (N1) was statistically significant. Amplitudes were higher in T group, but were not statistically different. The spinal cord intact area at the epicentre of the lesion was higher in the T group (1.23 +/- 0.8 mm(2) vs. 0.81 +/- 0.39 mm(2); P < 0.05). The extent of the lesion was higher in the C group (9.4 +/- 2.9 mm vs. 6.4 +/- 3.4 mm; P < 0.05). CONCLUSION: Intrathecal 0.5% bupivacaine provide a neuroprotective effect by decreasing functional, electrophysiological and anatomical consequences after a contusive spinal cord injury.