Reactions 1237 - 31 Jan 2009

Bupivacaine

High sensory levels following spinal anaesthesiain patients with lumbar spinal stenosis: 2 casereports

Two patients developed high sensory levels afterreceiving bupivacaine for spinal anaesthesia; both patientswere later found to have lumbar spinal stenosis.

A 40-year-old man, who had a history of pulmonarytuberculosis, presented for inguinal hernia repair; he had a3-month history of pain in both of his legs. During surgery,he received bupivacaine 12.5mg (0.5% hyperbaric) for asubarachnoid block at L3-L4 level in a left lateral position.After 5 minutes, his HR and BP decreased to 50 beats/minand 70/40mm Hg, respectively. He had difficulty breathingand numbness in his fingers. He received IV atropine, arapid infusion of Hartmann’s solution and 100% oxygen.His HR and BP increased to 75 beats/min and 85/50mm Hg,respectively. However, his breathing difficulty andnumbness increased. A sensory loss was confirmed in hisfingers. Surgery was then performed under generalanaesthesia with intubation and ventilation. Afterextubation, a pin prick method showed a T8 level ofsensory block. After being observed in an ICU for 6 hours,he was transferred to a postoperative ward. A spinal MRIlater revealed a significant spinal canal stenosis from L2 toL5 level along with other features suggestive of lumbarspinal tuberculosis. [Patient outcome not clearly stated.]

A 50-year-old man, who had lumbar spinal stenosis at L2to L4 level, presented for a patellectomy. He receivedbupivacaine 6.25mg (0.5% hyperbaric) in a left lateralposition and, after an unspecified duration, achieved a T4level of sensory block. [Patient outcome not stated.]

Author comment: "Lumbosacral cerebrospinal fluidvolume inversely correlates with peak sensory block level . . .Since the lumbar spinal cerebrospinal fluid volume becomesreduced due to canal stenosis, it leads to higher spread oflocal anaesthetic."Sharma R, et al. Lumbar canal stenosis: retrospective diagnosis after a high spinalblock. Anaesthesia and Intensive Care 37: 141-142, No. 1, Jan 2009 -India 801134884

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Reactions 31 Jan 2009 No. 12370114-9954/10/1237-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved