Intrathecal drug spread

Hocking, Grant; Wildsmith, J.A.W.

doi:10.1093/bja/aeh204

Cited by 312 publications

(267 citation statements)

References 137 publications

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“…6 Though commonly resulting in a more limited sensory blockade than plain solutions, 5,8 hyperbaric solutions have been shown to exhibit different patterns of dermatomal spread depending on the dextrose concentration and density. 14 Hallworth et al 19 and McLeod 20 reported that the addition of dextrose to bupivacaine produces solutions of predictable density in a linear manner, whereas the addition of fentanyl results in minimal changes to the final density of hyperbaric solutions.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Compared to plain solutions, hyperbaric solutions might provide a more predictable block with fewer side effects, such as high block, hypotension, nausea, vomiting and pruritus. 5 The use of hyperbaric solutions might risk ineffective analgesia from insufficient cephalad spread, however. 6 Literature guiding the choice of baricity of intrathecal solutions is conflicting and lacks evidence for both potential benefits and adverse effects.…”

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confidence: 99%

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Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Rofaeel

Lilker

Fallah

et al. 2007

Can J Anesth/J Can Anesth

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CAN J ANESTH 54: 1 www.cja-jca.org Januar y, 2007Purpose: Baricity is an important determinant of block characteristics of the spinal component of a combined spinal epidural (CSE) for labour analgesia. This study compares the analgesic efficacy and side effects of intrathecally administered plain and hyperbaric bupivacaine (both with fentanyl) during active labour.Methods: Sixty-two women in active labour (cervical dilatation ≥ 5 cm and pain score > 5) were randomized in a prospective, single-blinded fashion to receive 2.5 mg of either hyperbaric or plain bupivacaine both combined with 15 µg of fentanyl as the spinal component of a CSE. The primary outcome was failure of satisfactory analgesia within ten minutes of the intrathecal injection as defined by a verbal pain score > 3. Secondary outcomes included need for rescue analgesia, hypotension, respiratory depression, nausea and vomiting, pruritus and sustained fetal bradycardia. Results: Sixty patients were analyzed. The failure rates were 20% in the hyperbaric group vs 0% in the plain group (P = 0.024). The plain solution provided faster onset, higher sensory levels and less motor block at all times during the first 30 min. The incidence of both pruritus and sustained fetal bradycardia was 33% in the plain group and 10% in the hyperbaric group (P = 0.03). Conclusion:A plain rather than hyperbaric solution of bupivacaine 2.5 mg with fentanyl 15 µg provides a faster onset of analgesia, higher sensory levels and less motor block, while demonstrating an increased incidence of pruritus and sustained fetal bradycardia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Rofaeel

Lilker

Fallah

et al. 2007

Can J Anesth/J Can Anesth

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“…Hyperbaric local anesthetics have been used for many years due to their short duration of action and the safety of the procedure 7 . Compared to plain solutions, hyperbaric solutions might provide a more predictable block with fewer side effects, such as high block, hypotension, nausea, vomiting, and pruritus 8 . As hyperbaric solutions have higher density when compared with a reference standard, they develop enough interstitial pressure to cause diffusion of injected material in the dependent regions 9 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of two regional anesthetic methods on the front limb of dogs using hyperbaric bupivacaine

2010

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PURPOSE: To evaluate the effects of bupivacaine 0.5 and 0.25% in intravenous regional anesthesia (IVRA) and brachial plexus block (BPB), respectively, on anesthesia, motor block and cardiovascular parameters in dogs. METHODS: Fourteen healthy adult dogs averaging 10 kilograms (kg) of body weight. Animals were randomly assigned to receive one of the two treatments IVRA (n=7) or BPB (n=7). All the animals were sedated with acepromazine (0.1 mg/kg intramuscular). To execute the BPB was used an electrical nerve stimulation. Anesthesia, motor block, sedation, cardiovascular and respiratory effects were measured as effect of the treatment. RESULTS: BPA showed superior efficiency and duration of anesthesia (BPB - 456 ± 94 minutes vs IVRA - 138 ± 44) as well as motor block. There only physiologic parameter which change were the systolic pressure in BPB and respiratory rate for both treatments. CONCLUSION: In dogs the 0.25 % hyperbaric bupivacaine in BPB produces a front limb anesthesia about three times more than the 0.5 % in IVRA, with ptosis of the limb blocked and little interference in the cardiovascular system but with decrease in respiratory rate.

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“…Furthermore, since a solution of glucose-free bupivacaine is slightly hypobaric following spinal injection, some cephalad extension of the block might be expected if patients remain seated after injection. 19 By using the up-down sequential allocation technique, the median effective dose of intraspinal hyperbaric bupivacaine for CSE appeared to be 20% less in comparison with the median effective dose for a single shot spinal anesthesia. 20 Under similar clinical conditions, a 20% decrement in the dose of bupivacaine may be warranted whenever CSE is intended in place of single shot spinal anesthesia.…”

mentioning

confidence: 91%

“…En outre, comme une solution de bupivacaïne sans glucose est légèrement hypobare après une injection rachidienne, une extension du bloc en direction céphalique peut être présumée si les patients demeurent assis après l'injection. 19 En utilisant une technique de distribution verticale séquentielle, la dose efficace médiane de bupivacaïne hyperbare intrarachidienne pour la RPC semble être de 20 % infé-rieure à celle d'une seule dose pour la rachianesthésie. 20 Dans des conditions cliniques semblables, une diminution de 20 % de la dose de bupivacaïne peut être justifiée si une RPC est envisagée plutôt qu'une rachianesthésie réalisée avec une seule injection.…”

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Hemodynamic effects of central neural blockade in elderly patients

Veering

2006

Can J Anesth/J Can Anesth

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I N all developed countries in the world the elderly are now recognized as an increasing segment of the population. In one century the number of persons of 65 or older has increased three times perhaps because of better and more available medical care. By 2030, up to 20% of Western populations will be more than 65 yr of age. 1 The oldest old (people aged 80 and over) are the fastest growing segment of the older population. Improvements in surgical techniques, anesthesia and intensive care units have made surgical interventions in more and more older and sicker patients possible. Over half of the population older than 65 yr will require surgical intervention at least once during the remainder of their lives and have surgery four times more often than the rest of the population. 2 Accordingly, elderly patients will become a very large part of our anesthetic practice. The most common procedures, which are performed in the elderly, involve the cardiovascular system, the digestive system and musculoskeletal system.Regional anesthetic techniques (peripheral nerve blockade, central neural blockade) are frequently used in elderly patients, especially during orthopedic surgery, genito-urological, abdominal and gynecological procedures.Systemic hypotension and bradycardia are the most common cardiovascular disturbances associated with central neural blockade, with a particularly frequent incidence in the elderly. 3 Systemic hypotension occurs from decreases in systemic vascular resistance and central venous pressure from sympathetic block with vasodilatation and redistribution of central blood volume to lower extremities and splanchnic beds. 4 Marked hypotension may be especially harmful to elderly patients with limited cardiac reserve. Besides, elderly patients have decreased physiological reserve and an increased incidence of systemic disease. Normal aging is associated with a reduction in the baroreceptor-reflex mediated heart rate response to hypotensive stimuli. 5 Consequently elderly patients may not respond with the same degree of sympathetic activity as younger patients. Decreased cardiac reserves, structural changes in the arterioles and changes in the autonomic nervous system with increasing age may also play a role.High levels of sensory anesthesia and increasing age appeared to be the two main risk factors for the development of hypotension after spinal anesthesia. 6 In elderly patients both epidural and spinal anesthesia are associated with increased levels of analgesia. [7][8][9][10][11][12] The level of analgesia increases with advancing age after lumbar epidural administration of a given dose (fixed volume and concentration) of a local anesthetic solution 7-9 and following thoracic epidural administration of a fixed dose. 11 Increased levels of analgesia with advancing age have been attributed to reduced leakage of local anesthetic solution, because of progressive sclerotic closure of intervertebral foramina. As the fatty tissue degenerates with advancing age, the epidural space becomes more compliant and ...

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Intrathecal drug spread

Cited by 312 publications

References 137 publications

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Bupivacaïne intrathécale pure vs hyperbare pour l’analgésie du travail obstétrical: efficacité et effets secondaires

Evaluation of two regional anesthetic methods on the front limb of dogs using hyperbaric bupivacaine

Hemodynamic effects of central neural blockade in elderly patients

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