No abstract

We have studied prospectively 600 patients who had spinal anaesthesia for minor surgery, to evaluate the incidence of transient radicular irritation after the block. The anaesthetic agent (hyperbaric 5% lignocaine, hyperbaric 0.5% bupivacaine or plain 0.5% bupivacaine) was chosen according to the anticipated duration of surgery. We obtained information after operation from 537 patients (282 by telephone, 255 by letter). Ten percent of patients anaesthetized with hyperbaric 5% lignocaine (27 patients) had transient bilateral radiating pain in the lower extremities, buttocks, or both. Typically the pain started within 24 h after spinal anaesthesia, lasted less than 2 days and was described as mild. Lignocaine was the only variable that correlated with this pain. Two patients complained of symptoms after hyperbaric 0.5% bupivacaine but these were atypical compared with pain after lignocaine. None of the patients anaesthetized with plain bupivacaine had similar complaints. We conclude that the use of 5% hyperbaric lignocaine for spinal anaesthesia should be reconsidered.

No abstract

Three patients in the morphine group and one patient in the femoral group did not need any additional Major knee surgery is associated with moderate or oxycodone. In the morphine group on average 2.8 severe post-operative pain. Intrathecal morphine and (range 0-7) and in the femoral group 3.2 (0-5) adcontinuous femoral 3-in-1 block were compared proditional doses of oxycodone were needed during the spectively in 40 patients for pain after major knee 24 h observation period. The mean pain scores were surgery under spinal anaesthesia, with 4mL isobaric significantly lower in the morphine group at 9 and 0.5% bupivacaine. In a random order, 20 patients re-12 h into the 24-h trial. Itching was seen only in the ceived preservative free morphine 0.3 mg mixed with morphine group (40% of the patients). Other side spinal bupivacaine. In 20 patients, following spinal effects were similar in the two groups. All patients anaesthesia with only bupivacaine, femoral 3-in-1 were satisfied with their pain therapy. Both intrathecal block was performed post-operatively with 0.5% bumorphine and femoral 3-in-1 block alone were inpivacaine 2 mg kg −1 . The block was continued via a sufficient for the treatment of severe pain after major catheter with 0.25% bupivacaine 0.1 mL h −1 kg −1 until knee surgery. the next morning (24 h after induction of spinal anaesthesia). Intramuscular oxycodone was given as a Keywords: anaesthetic techniques, regional, spinal; femoral block, analgesia; post-operative, intrathecal rescue analgesic in all patients. Two patients from the femoral group were excluded due to technical failure. morphine.

SummaryFifty-four patients were studied prospectively to evaluate home-readiness after a small dose (1 or 2 ml) of subarachnoid hyperbaric 0.5% bupivacaine. The block regressed significantly earlier in the 1 ml group than in the 2 ml group (p < 0.05). The patients were also able to walk significantly earlier in the 1 ml group (median 161 min and 231 min in the 1 ml and 2 ml groups, respectively) (p < 0.05). However, there were no significant differences between the groups in time of ability to void. We conclude that adequate surgical anaesthesia can be achieved with small doses of hyperbaric bupivacaine used for spinal anaesthesia. Although the sensory and motor block after 1 or 2 ml hyperbaric bupivacaine recovered within a reasonable time for day-case surgery, in some patients recovery of the ability to void was delayed to an undesirable extent. [6][7][8]. The use of bupivacaine in spinal anaesthesia is rarely followed by transient neurological symptoms [9]. We therefore studied prospectively the quality of spinal anaesthesia with small doses of hyperbaric 0.5% bupivacaine and paid special attention to patients' home-readiness following the block. Patients and methodsFifty-four ASA I or II patients scheduled for procedures with expected duration less than 1 h (minor orthopaedic, urology or anal surgery) gave their informed consent to participate in the study. The study was approved by the Ethics Committee of the hospital. Obese patients (body mass index greater than 30) or patients with pulmonary or cardiac disease were not studied.The patients were premedicated with diazepam 0.2 mg. kg ¹1 orally 60 min before arrival in the operating theatre.