Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block

Background Several factors are thought to affect the spread and duration of spinal anesthesia (SA) in adults. These include the volume of cerebrospinal fluid (CSF) in the lumbar spinal canal, which has a negative correlation with both the spread and duration of the sensory block. Objectives We evaluated whether CSF aspiration before an injection of levobupivacaine affected the spread or duration of SA in children. Patients and Methods SA was induced by levobupivacaine (5 mg/mL, 0.25 - 0.5 mg/kg) in 186 children aged 10 months to 18 years (mean of 7.5 years). Two groups were analyzed prospectively: 93 children from which 1 - 3 mL of CSF (CSF-aspiration group) was aspirated before the injection of levobupivacaine to induce SA and 93 children from which no CSF was aspirated (no-CSF-aspiration group) prior to the injection of levobupivacaine. The main outcome measure was regression of the sensory block below T10, cephalic spread of the block, and postpuncture complications after SA. Results There were no between-group differences in the time to regression of the block below T10 or in the cephalic spread of the sensory block: 94 (27) minutes and T4.4 (SD 2.2) in the CSF-aspiration group, respectively, vs. 97 (29) minutes and T4.3 (1.8), respectively, in the no-CSF-aspiration group. Position-dependent headaches developed in 4 of 91 children in the CSF-aspiration group and 5 of 86 children in the no-CSF-aspiration group, but no epidural blood patches were required. Conclusions The aspiration of 1 - 3 mL of CSF before an injection of levobupivacaine did not seem to affect the spread and duration of the sensory block or postpuncture complications in children following SA.

[1]  H. Kokki,et al.  Epidural blood patches are effective for postdural puncture headache in pediatrics – a 10‐year experience , 2012, Paediatric anaesthesia.

[2]  A. Bosenberg.  Benefits of regional anesthesia in children , 2012, Paediatric anaesthesia.

[3]  H. Kokki.  Spinal blocks , 2012, Paediatric anaesthesia.

[4]  F. Madadi,et al.  Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients , 2011, Anesthesiology and pain medicine.

[5]  T. Parrish,et al.  Lumbosacral Cerebrospinal Fluid Volume in Humans Using Three-Dimensional Magnetic Resonance Imaging , 2006, Anesthesia and analgesia.

[6]  H. Kokki,et al.  Cerebrospinal fluid insulin‐like growth factors IGF‐1 and IGF‐2 in infantile autism , 2006, Developmental medicine and child neurology.

[7]  A. Faldum,et al.  Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial , 2005, Developmental medicine and child neurology.

[8]  H. Kokki,et al.  High success rate and low incidence of headache and neurological symptoms with two spinal needle designs in children * , 2005, Acta anaesthesiologica Scandinavica.

[9]  Y. Adachi,et al.  The Influence of Lumbosacral Cerebrospinal Fluid Volume on Extent and Duration of Hyperbaric Bupivacaine Spinal Anesthesia: A Comparison Between Seated and Lateral Decubitus Injection Positions , 2005, Anesthesia and analgesia.

[10]  K. Korttila,et al.  Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anesthesia for ambulatory knee arthroscopy , 2005 .

[11]  P. Kranke,et al.  The Development and Validation of a Risk Score to Predict the Probability of Postoperative Vomiting in Pediatric Patients , 2004, Anesthesia and analgesia.

[12]  D. Rating,et al.  Headache and backache after lumbar puncture in children and adolescents: a prospective study. , 2004, Pediatrics.

[13]  H. Kokki,et al.  Levobupivacaine for Pediatric Spinal Anesthesia , 2004, Anesthesia and analgesia.

[14]  H. Kokki,et al.  Epidural blood patch for management of postdural puncture headache in adolescents , 2002, Acta anaesthesiologica Scandinavica.

[15]  H. Kokki,et al.  Management of postdural puncture headache with epidural blood patch in children , 2002, Paediatric anaesthesia.

[16]  E. Herrgård,et al.  Postdural puncture headache is not an age‐related symptom in children: a prospective, open‐randomized, parallel group study comparing a22‐gauge Quincke with a 22‐gauge Whitacre needle , 1999, Paediatric anaesthesia.

[17]  W. Schobersberger,et al.  Immune response and iron metabolism. , 1998, British journal of anaesthesia.

[18]  H. Kokki,et al.  Spinal anaesthesia for paediatric day-case surgery: a double-blind, randomized, parallel group, prospective comparison of isobaric and hyperbaric bupivacaine. , 1998, British journal of anaesthesia.

[19]  Spencer S. Liu,et al.  Lumbosacral Cerebrospinal Fluid Volume Is the Primary Determinant of Sensory Block Extent and Duration during Spinal Anesthesia , 1998, Anesthesiology.

[20]  E. Doyle,et al.  Modifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia , 1998, Paediatric anaesthesia.

[21]  B. Jawan,et al.  The effect of removal of cerebrospinal fluid on cephalad spread of spinal analgesia with 0.5% plain bupivacaine , 1990, Acta anaesthesiologica Scandinavica.

[22]  P. Rosenberg,et al.  Effect of Aspiration of Cerebro‐Spinal Fluid on Spinal Anaesthesia with Isobaric 0.5% Bupivacaine , 1985, Acta anaesthesiologica Scandinavica.

[23]  N. M. Greene.  Distribution of Local Anesthetic Solutions within the Subarachnoid Space , 1985, Anesthesia and analgesia.

[24]  L. L. Michaelis,et al.  Dose‐related Prolongation of the Bleeding Time by Intravenous Nitroglycerin , 1985, Anesthesia and analgesia.

[25]  R. Porter,et al.  Backache and the Lumbar Spinal Canal , 1980, Spine.

[26]  P. Bromage.  A Comparison of the Hydrochloride and Carbon Dioxide Salts of Lidocaine and Prilocaine in Epidural Analgesia , 1965, Acta anaesthesiologica Scandinavica. Supplementum.