Bupivacaine spinal administration

Chabbouh T, Lentschener C, Zuber M, Jude N, Delaitre B, Ozier Y. Persistent cauda equina syndrome with no identifiable facilitating condition after an uneventful single spinal administration of 0.5% hyperbaric bupivacaine. Anesth Analg 2005 101 (6) 1847-8. 

A 26-year-old woman with a history of multiple substance abuse required emergency caesarean section at 30 weeks of gestation as a result of crack cocaine-induced placental abruption and fetal distress (251). Her admission blood pressure was 145/95 mmHg, heart rate 95/minute and respiratory rate 20/minute. The fetal heart rate was 130/minute and non-reactive, with late and variable decelerations and no response to maternal oxygen administration. Spinal block with bupivacaine, fentanyl, and morphine was performed with the patient in a sitting position. No maternal or neonatal postoperative complications were reported. 

Different combinations of fentanyl, bupivacaine, and clonidine were investigated in a multicenter (6 sites) trial of 78 women undergoing elective cesarean section under spinal block (30). In some cases, this appeared to imply intrathecal administration, and in others combined intrathecal and epidural administration. Patients received hyperbaric bupivacaine alone, or with 75 pg of clonidine, or with 75 pg of clonidine and 12.5 pg of fentanyl. There were no reported hemodjmamic differences between the groups, but sedation and pruritus were significantly more common in those who received fentanyl, occurring in 65% and 25% of... 

The addition of ketamine to bupivacaine for spinal anesthesia has been studied in 60 patients undergoing spinal anesthesia for insertion of intracavitary brachyther-apy implants for cervical carcinoma (8). They were randomly assigned to receive either bupivacaine 10 mg or bupivacaine 7.5 mg plus ketamine 25 mg. Motor recovery was significantly quicker in the ketamine group. Blood pressure was significantly lower in the bupivacaine group 5 minutes after administration, and perioperative... 

In this case the authors felt that although the initial picture looked like the effects of subdural injection of bupi-vacaine and fentanyl, the prolonged coma with high motor blockade was more reminiscent of total spinal injection. They postulated that delayed total spinal anesthesia had occurred in this patient as a result of the epidural administration of a large quantity of bupivacaine and fentanyl via a hole made in the dura during the first attempt at epidural insertion. 

A 20-year-old woman who received a combined spinal epidural for labor had a respiratory arrest 23 minutes after the administration of sufentanil 10 micrograms and bupivacaine 2.5 mg (199). 

In some series, transient hearing loss after anesthesia with bupivacaine was found with intrathecal but not epidural administration (SEDA-13, 99) (SEDA-16, 129)(263). It has been suggested that the cause could be a reduction in CSF pressure transmitted through the cochlear aqueduct (264), a hypothesis that has been both supported and criticized (SEDA-16,129). Sensorineural hearing loss after spinal anesthesia with bupivacaine has been thought to be due to the entry of bupivacaine into the inner ear, resulting in a direct effect on its functional apparatus (265). 

Kuczkowski KM. Respiratory arrest in a parturient following intrathecal administration of fentanyl and bupivacaine as part of a combined spinal-epidural analgesia for labour. Anaesthesia 2002 57(9) 939 0. 

Effective in the management of severe postoperative, chronic, or cancer pain. Spinal opioids can be administered by a single bolus injection into the epidural or subarachnoid space or by continuous infusion via an indwelling catheter. Dosage requirement by these routes is significantly less than with IV administration (epidural opioid doses 10-fold lower than IV doses intrathecal opioid doses 100-fold lower than IV doses). Morphine, hydromorphone, fentanyl, and sufentanil are effective when administered intrathecally. The most commonly used local anesthetic in continuous epidural infusions is bupivacaine. Fentanyl, morphine, or hydromorphone is usually combined with bupivacaine for epidural infusions. 

Bupivacaine (e.g., Marcaine) Infiltration, spinal, epidural, and nerve block anesthesia. Long duration increases utility for epidural block during labor. Similar to lidocaine. IV administration may induce ventricular arrhythmias. 

A 35-year-old woman developed involuntary rhythmic movements of her right leg after recovery from a spinal anesthetic for surgical treatment of peroneal tendonitis. At a second operation within 1 year myoclonus recurred about 100 minutes after intrathecal administration of 9 mg of heavy bupivacaine 0.5%, with bilateral involuntary myoclonic movement of both legs and arms. The symptoms disappeared after 4 hours and there were no abnormal neurological or laboratory findings. 

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