SummaryA patient is presented who developed severe pain in both legs, that began 5 h after a spinal anaesthetic with lignocaine 5% in dextrose 7.5%, but lasted for less than 24 h. Key wordsAnaesthesia, regional; spinal. Complications; neurological. Anaesthetics, local; lignocaine, hyperbaric.Since its introduction as a local anaesthetic for spinal anaesthesia in the late 1940s [l], lignocaine has been used frequently, especially for short procedures. It is generally regarded as a safe spinal anaesthetic agent, with few neurological sequelae having been reported [2]. Since 1991, however, patients have been described who have developed permanent or transient neurological symptoms after spinal anaesthesia with lignocaine in dextrose, some of whom had received a catheter technique [3-51. The authors present a patient who developed severe pain in both legs during the first day after spinal anaesthesia with a hyperbaric lignocaine solution. Case historyA 63-year-old man was scheduled for transurethral resection of a localised bladder tumour. The patient was not receiving any medication, and had no history of allergy or central nervous system disease. He had previously had two transurethral bladder tumour resections, the first one 9 months before and the second 6 months before, and for both of these spinal anaesthesia had been performed using hyperbaric lignocaine 5%.At the pre-operative visit the patient described his spinal anaesthetics as having been uneventful, and the records from the two previous admissions, including the anaesthetic records, were unremarkable. Physical examination was normal except for signs of mitral regurgitation (the existence of which was already known), without evidence of cardiac insufficiency. The patient agreed to undergo a further spinal anaesthetic.After receiving a premedication and prophylatic antibiotics the patient was placed in the left lateral position, and the skin over the lumbar area was cleansed with a 10% iodine solution (Betadine, Mundipharma Pharmaceutical Co.). After removal of excess iodine solution the skin was infiltrated with 1.5 ml of lignocaine 1%. A lumbar puncture was performed with a 27-G Quincke type needle (Spinocan, B. Braun Melsungen AG) inserted through an introducer needle (20-G) between the third and fourth lumbar vertebra, without difficulty, using the paramedian approach. Approximately 0.2 ml of cerebrospinal fluid was aspirated and 80 mg of lignocaine 5% in 7.5% dextrose (Xylocaine heavy Astra Pharmaceutica AG) was injected. The patient did not experience pain or paraesthesia during either the lumbar puncture or the injection of the lignocaine. The patient was turned on his back and about 10 min later, when he had an upper sensory level of T, , , , he was placed in the lithotomy position. Blood pressure remained stable and the resection was uneventful. The total time spent in the lithotomy position was 40-45 min.The immediate postoperative course was uneventful, and 4 h after the lumbar puncture the patient was able to walk around without problems. Howe...

Both groups had low pain scores with few and comparable adverse effects. It thus seems that the volume is not important when mixtures of bupivacaine and fentanyl in the studies concentrations are infused epidurally at a low thoracic level. Practical reasons favour the higher concentration mixture.

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Respiratory and circulatory conditions that could have an influence on measurements of pallor of the papilla were evaluated with our photopapillometer in a controlled study on canines. The brightness of the papilla rim and the width of the arterioles emerging from the optic nerve head were measured in six anesthetized dogs under normal, hypertensive, and hypotensive circulatory conditions, as well as under various respiratory manipulations, and the parameters were compared for statistical correlation. Both brightness and vessel width remained constant for a wide range of arterial pressures when the rest of the experimental conditions were kept stable at naturally occurring levels. If respiration and circulation were brought to extreme levels, however, there was a statistical tendency for the brightness of the papilla to be dependent on arterial and pulmonary arterial blood pressure. The importance of these findings is discussed with regard to their influence on objective measurements of fundus brightness.

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