Comparison of Continuous Spinal with Combined Spinal-Epidural Anesthesia Using Plain Bupivacaine 0.5% in Trauma Patients

• Published in: Anesthesia and analgesia Vol. 85; no. 1; pp. 69 - 74
• Main Authors: Wilhelm, Stefan, Standl, Thomas, Burmeister, Marc, Kessler, Gerhard, am Esch, Jochen Schulte
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.07.1997; Lippincott
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia, Epidural - adverse effects; Anesthesia, Spinal - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - adverse effects; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Catheterization; Female; Humans; Leg Injuries - surgery; Local anesthesia. Pain (treatment); Male; Medical sciences; Middle Aged; Prospective Studies; Local anesthetic; Human; Analgesia; Associated technique; Regional anesthesia; Bupivacaine; Extradural administration; Complication; Trauma; Intrathecal administration; Anilide; Comparative study
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199707000-00013

We investigated the efficacy and complications of microcatheter spinal anesthesia (CSA) in comparison to a combined spinal-epidural technique (CSE) using plain bupivacaine 0.5%. Sixty trauma patients randomly received either CSA using a 22-gauge Sprotte needle and a 28-gauge microcatheter or CSE after insertion of a 22-gauge epidural catheter through an 18-gauge Tuohy needle followed by dural puncture with a 25-gauge pencil-point needle inserted through the backeye of the Tuohy needle. An initial subarachnoid bolus of 2 mL of plain bupivacaine 0.5% was injected. If analgesia did not reach T12 within 20 min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5 mL in the CSA group or 16 mL in the CSE group. Mean arterial blood pressure, heart rate, and analgesic levels were recorded. On postoperative Day 4, patients were interviewed for postanesthetic complaints. Technical problems were more frequent in the CSE group than in the CSA group (47% vs 13%). Performance of anesthesia was faster (8 +/- 3 vs 15 +/- 8 min) and the total dose of bupivacaine lower (3.2 +/- 1.0 vs 9.7 +/- 5 mL) in patients who received CSA. The incidence of hypotension did not differ significantly. However, more patients in the CSE group were treated for bradycardia (4 vs 0). The number of patients suffering from postdural puncture headache was comparable in both groups, but there were more patients with lower back pain in the CSE group (8 vs 2). In conclusion, our data suggest that microcatheter CSA is not associated with an increased rate of complication in patients with lower limb fractures.(Anesth Analg 1997;85:69-74)