Spinal anaesthesia for paediatric day-case surgery: a double-blind, randomized, parallel group, prospective comparison of isobaric and hyperbaric bupivacaine

Abstract

We have compared bupivacaine 5 mg ml-1, either isobaric in saline 0.9% or hyperbaric in 8% glucose, for spinal anaesthesia in 100 children, aged 2-115 months, in a double-blind, randomized, parallel group, prospective study. Children were premedicated with diazepam 0.5 mg kg-1 orally. Seventy-two children were sedated before, and 25 children after, lumbar puncture, with either propofol or thiopental (thiopentone). After lumbar puncture in the lateral decubitus position with a 24-27-gauge paediatric spinal needle, isobaric or hyperbaric bupivacaine 5 mg ml-1 was injected in a dose of 0.3-0.5 mg kg-1 using a blinded procedure. Maximum cephalad extent of the block was tested by transcutaneous electrical stimulation. The success rate of the block was greater with hyperbaric bupivacaine (96%) compared with isobaric bupivacaine (82%) (P = 0.025, 95% confidence intervals (CI) 0-28%). Intense motor block was associated with adequate sensory block. Spread and duration of sensory block showed a similar wide scatter in both groups. The highest median level of sensory block was T4 (range T1-12) in the isobaric group and T4 (T1-7) in the hyperbaric group. Times to two segment regression of block were similar: 80 (55-190) min in the isobaric and 80 (30-190) min in the hyperbaric group. Cardiovascular stability was good. Etilefrin was administered to one child to treat hypotension and atropine to one child to treat bradycardia. The study gave an impression of a delayed onset time of spinal block, as most of the nine children who required either fentanyl or a sedative for a mild reaction to skin incision had complete block when transferred to the recovery room after operation. Five children developed a mild, position-dependent headache.

Comparison Between Spinal Anaesthesia With Propofol Sedation and General Anaesthesia in Children of 2-5 Years of Age Undergoing Infraumbilical Surgeries

“…They used a dose of 0.5 mg/kg for children weighing less than 10 kg and 0.4 mg/kg for children weighing 11 to 19 kg in one study. 5 and a dose of 0.4 mg/kg in another study. 6 The time to first analgesic requirement in the current study (75 minutes, median value) is comparable to the earlier studies.…”

“…6 The time to first analgesic requirement in the current study (75 minutes, median value) is comparable to the earlier studies. 5,6 Slight higher dose of hyperbaric bupivacaine (0.5 mg/kg) was used in the present study compared to those earlier studies. Spinal anaesthesia produces relatively shorter duration of block in paediatric population compared to the adults due to higher cardiac output and regional blood flow.…”

Raquianestesia com Bupivacaína a 0,5% Isobárica para cirurgia pediátrica ambulatorial em pacientes com idades de 6 a 12 anos: estudo prospectivo

“…Entretanto, nenhuma necessitou de vasopressor para correção da pressão arterial. Da mesma forma que com a lidocaína a 5% 11 . É razoável esperar a redução na incidên-cia e gravidade da cefaléia pós-raquianestesia quando se utiliza agulha de fino calibre 17 .…”

“…Local anesthetics' baricity is a major factor influencing drug's spread in the CSF 10 . Hyperbaric 2,3,11 and isobaric 8,11 solutions are used in pediatric spinal anesthesia with excellent results. This study aimed at evaluating clinical characteristics of 0.5% isobaric bupivacaine for spinal anesthesia in pediatric surgeries.…”

“…A baricidade do anestésico local é um dos mais importantes fatores que influencia a distribuição do anestésico dentro do LCR 10 . Soluções hiperbáricas 2,3,11 e isobáricas 8,11 são utilizadas em raquianestesia de crianças com excelentes resultados. O objetivo deste estudo foi avaliar as características clínicas da bupivacaína a 0,5% isobárica em raquianestesia para cirurgias pediátricas.…”