Mental Status Change and Aphasia After Labor Analgesia with Intrathecal Sufentanil/Bupivacaine

Fragneto, Regina; Fisher, A A

doi:10.1097/00000539-200005000-00033

Cited by 29 publications

(13 citation statements)

References 8 publications

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“…[13][14][15] The side-effect profile of intrathecal sufentanil is dose-dependent 16 and includes pruritus, nausea, vomiting, dysphagia, respiratory depression, shivering, high sensory block, sedation, dysphoria and muscle spasms. [3][4][5][6][7][8] With the exception of pruritus and transient difficulty in swallowing, our patient had minimal side effects. Due to the large dose she received, we expected her to experience more dramatic side effects, including respiratory depression.…”

Section: Discussionmentioning

confidence: 63%

“…Potential side effects associated with intrathecal sufentanil include pruritus, nausea, vomiting, dysphagia, respiratory depression, shivering, high sensory block, sedation, hypotension, dysphoria, muscle spasms and sensory changes that can be disconcerting for patients. [3][4][5][6][7][8] Although side effects are typically dose-dependent, sufentanil doses less than 5 lg can cause undesirable effects. We describe both the analgesia and side effects of 45 lg of intrathecal sufentanil in a woman receiving a CSE for labor analgesia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Coleman

Carvalho

Lipman

et al. 2009

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Coleman

Carvalho

Lipman

et al. 2009

International Journal of Obstetric Anesthesia

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“…Since the subdural space extends cranially, local anaesthetic block of the brainstem is possible causing loss of consciousness and apnoea. 6,7 Transient aphasia in our patient could be explained due to the effect of bupivacaine on the brain stem cranial nerves. Although it is difficult to prove or disprove subdural injection in this case, the progression of events can be explained on the basis of subdural injection of local anaesthetic.…”

Section: Discussionmentioning

confidence: 66%

Subdural block: A possible cause of transient aphasia following spinal anaesthesia

Bhardwaj¹,

Kiran²,

Kaur³

et al. 2015

Sri Lankan J Anaesthesiol

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Central neuraxial blockade is a commonly performed anaesthetic technique for lower limb orthopaedic surgeries. Although it is considered a safe and reliable technique, occasionally an unexpectedly high or low level of block can be achieved due to accidental injection of local anaesthetic in a meningeal plane other than that desired. Here we report a young male who complained of aphasia and difficulty in breathing immediately after spinal anaesthesia. He had a high sensory block extending to C3 dermatome. His haemodynamics remained stable throughout the surgery. Speech returned to normal in 15 minutes. Subdural block was speculated as a cause for this unusual presentation.Keywords: subdural block, aphasia, spinal anaesthesia Case ReportCentral neuraxial blockade is a common anaesthetic technique for lower limb orthopaedic surgeries. Although it is considered a safe and reliable technique, occasionally an unexpectedly high or low level of block occurs due to accidental injection of local anaesthetic in a meningeal plane other than that desired.1 Even cardiac arrests have been reported despite stable haemodynamics.2 A greater awareness about variable presentations is important as timely management is essential to avoid critical complications. We hereby report a case that developed aphasia with unexpectedly high sensory level immediately following spinal anaesthesia.A 19 year old male weighing 65 kg, with a height of 167cm belonging to ASA physical status 1 came to emergency operation theatre for interlocking nail for fracture shaft of right femur. His general physical status and all haematological investigations were unremarkable.In the operation theatre, routine monitors were attached and his vital signs recorded. Peripheral venous line was established with 18G cannula on right forearm and Ringer's lactate infusion was started. Under aseptic precautions subarachnoid block was given with 23G Quinke's needle in L3/4 space in midline in sitting position in a single atraumatic attempt. Hyperbaric bupivacaine (0.5%) 2.8ml was injected after obtaining clear free flow of cerebrospinal fluid. As the patient was placed in supine position, he became restless and was unable to speak. Immediately 100% oxygen was administered. His spontaneous respiratory efforts were apparently normal. His heart rate was 86/min, regular, blood pressure was 128/64 mmHg and oxygen saturation (SpO2) 98%. Within few seconds, he started sweating with irregular breathing. His breathing was assisted manually with few breaths with a Bain's circuit. He communicated only by moving his head. Level of the spinal block was assessed quickly and it was C3. After five to seven minutes, he started feeling comfortable, sweating decreased and was able to speak in a weak voice. His speech reverted to normal voice in fifteen-twenty minutes. After 20 minutes, sensory level of block had receded to T4. At this time, surgery was commenced and it went on uneventfully for 90 minutes. His haemodynamic parameters were within normal range throughout the surgery. At the tim...

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“…1 Intrathecal injection of sufentanil can cause hypotension, respiratory arrest, changes in mental status, aphasia and cerebral thrombosis. [17][18][19] However, no side effects like these had been reported after epidural injection.…”

Section: Group 1 Group 2 Pmentioning

confidence: 99%

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

Çakirca¹,

Bektaş²,

Özcan³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : Addition of opioids to local anesthetics for epidural obstetric analgesia provides effective analgesia with decreased side effects. We compared the analgesic quality of 0,0625% bupivacaine and 0,1% bupivacaine with 0.5 μg/mL sufentanil. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Study participants were 18-45-year-old, primiparous 30 parturients. An epidural catheter was placed, 8-10 mL of 0.0625% bupivacaine with 0.5 μg/mL sufentanil and 0.1% bupivacaine with 0.5 μg/mL sufentanil were given to Group I and Group II, respectively. Hemodynamic parameters, obstetric examination findings, pain grades, time to reach visual analog scale (VAS)<4 and the first dose interval were recorded. Satisfaction levels, motor and sensorial blocks, oxytocin and valetamate bromide consumption, side effects were assessed. Total and additional drug use, duration of second stage of the delivery, mean delivery times, instrumental delivery, Apgar scores, fetal heart rates and uterine contraction pressures were recorded. The percentage of participation of the parturients to the delivery was assessed. R Re es su ul lt ts s: : Median VAS values were significantly lower in Group II. Median VAS values were lower than 4 in both groups after 15 th minute. The time to the second analgesic dose was longer in Group II. Systolic, diastolic and mean arterial blood pressures were measured lower in Group II. Satisfaction scores were significantly higher in Group II. C Co on nc cl lu us si io on n: : In the present study, satisfactory analgesia was produced in both groups. Although median VAS scores were lower in Group II, VAS<4 could be reached in Group I. We concluded that 0.0625% bupivacaine+0.5 μg/mL sufentanil combination, as providing VAS<4, could be a preferable alternative to 0.1% bupivacaine+0.5 μg/mL sufentanil. K Ke ey y W Wo or rd ds s: : Analgesia, obstetrical; analgesia, epidural Ö ÖZ ZE ET T A Am ma aç ç: : Epidural obstetrik analjezi için lokal anesteziklere opioidlerin eklenmesi daha efektif bir analjezi sağlar ve yan etkileri azaltır. Biz bu çalışmada %0,0625 bupivakain ve %0,1 bupivakaine 0,5 mikrog/mL sufentanil ekleyerek analjezi kalitesini karşılaştırdık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya, 18-45 yaşları arasında, 30 primipar gebe dahil edildi. Epidural kateter yerleştirildikten sonra %0,0625 bupivakain ile 0,5 mikrog/mL sufentanil veya %0,1 bupivakain ile 0,5 mikrog/mL sufentanil sırasıyla Grup I ve Grup II olarak belirlendi ve 8-10 mL uygulandı. Hemodinamik parametreler, obstetrik muayene bulguları, ağrı düzeyleri, vizuel analo skala (VAS)<4 olma zamanı ve ilk analjezik gereksinim zamanı kayıt edildi. Memnuniyet dereceleri, motor ve duyusal blok, oksitosin ve valetamat bromür kullanımı ve yan etkiler değerlendirildi. Toplam ve ek ilaç kullanımı, doğumun 2. evresinin süresi, doğumun toplam süresi, doğumda yardımcı alet kullanımı, Apgar skorları, fetal kalp hızı ve uterin kontraksiyon basınçları kayıt edildi. Gebelerin doğuma katılı...

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Mental Status Change and Aphasia After Labor Analgesia with Intrathecal Sufentanil/Bupivacaine

Cited by 29 publications

References 8 publications

Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Accidental intrathecal sufentanil overdose during combined spinal-epidural analgesia for labor

Subdural block: A possible cause of transient aphasia following spinal anaesthesia

Comparison of Two Different Bupivacaine Doses with Sufentanil for Epidural Obstetric Analgesia

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