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British Journal of Anaesthesia, Vol 77, Issue 4 544-545, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia

SHORT COMMUNICATION

Evaluation of the usefulness of intrathecal bupivacaine infusion for analgesia after hip and knee arthroplasty

L. Niemi, M. Pitkanen, P. Dunkel, E. Laakso and P. H. Rosenberg
Department of Anaesthesiology, Toolo Hospital, Helsinki University Central Hospital, FIN00260 Helsinki, Finland

Spinal anaesthesia in 47 ASA I-III patients was induced with 0.5% bupivacaine 2 ml via a 28-gauge spinal catheter (L3-4 interspace) and 0.5-ml increments were given if needed before or during hip or knee arthroplasty. Intrathecal 24-h infusions consisted of 0.5% bupivacaine 0.4 ml h-1 (2 mg h-1) (n = 12), 0.5% bupivacaine 0.2 ml h-1 (1 mg h-1) (n = 12) or saline (n = 11) (12 exclusions). Patients received oxycodone 0.1-0.14 mg kg-1 i.m. for rescue analgesia. Infusion of bupivacaine 2 mg h-1 provided significantly better postoperative analgesia (19 oxycodone doses per group in 24 h) compared with bupivacaine 1 mg h-1 (36 doses of oxycodone per group) and saline (52 doses per group) (P < 0.05). Five patients in the bupivacaine 2-mg h-1 group and none in the other groups had measurable sensory block 24 h after the infusion was started. Three patients in the bupivacaine 2-mg h-1 group, two with concomitant arterial hypotension, and one patient in the bupivacaine 1-mg h-1 group experienced an increase in block on the ward. The incidence of nausea and vomiting was similar in all groups. Although an effective analgesic, intrathecal infusion of bupivacaine 2 mg h-1 cannot be recommended for routine pain relief because of the risk of increasing spinal block. Technical problems (19%) also reduced the overall efficacy of the continuous intrathecal analgesic regimen.
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J. G. Forster, P. H. Rosenberg, and T. T. Niemi
Continuous spinal microcatheter (28 gauge) technique for arterial bypass surgery of the lower extremities and comparison of ropivacaine with or without morphine for postoperative analgesia
Br. J. Anaesth., September 1, 2006; 97(3): 393 - 400.
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