BJA Advance Access originally published online on March 26, 2009
British Journal of Anaesthesia 2009 102(6):832-838; doi:10.1093/bja/aep049
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Bupivacaine concentrations in the lumbar cerebrospinal fluid of patients during spinal anaesthesia
1 Department of Anaesthesia
2 Department of Clinical Pharmacology and Toxicology, University Hospital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland
* Corresponding author. E-mail: mseeberger{at}uhbs.ch
Background: Data on bupivacaine concentrations in the cerebral spinal fluid (CSF) during spinal anaesthesia are scarce. The purpose of this study was to determine the concentration of bupivacaine in the lumbar CSF of patients with an adequate level of spinal anaesthesia after injection of plain bupivacaine 0.5%.
Methods: Sixty patients with an adequate level of spinal block after standardized administration of plain bupivacaine 20 mg in men and of 17.5 mg in women were studied. To measure the CSF bupivacaine concentration, we performed a second lumbar spinal puncture and obtained a CSF sample at a randomized time point 5–45 min after the bupivacaine injection. In addition, we calculated the half-life of bupivacaine in the CSF and tested the hypothesis that the level of spinal block is related to the lumbar CSF bupivacaine concentration.
Results: Men and women had CSF bupivacaine concentrations ranging from 95.4 to 773.0 µg ml–1 (median 242.4 µg ml–1) and from 25.9 to 781.0 µg ml–1 (median 187.6 µg ml–1), respectively. The large variability of bupivacaine concentrations obtained at similar times after subarachnoid administration made calculation of a meaningful half-life of bupivacaine in CSF impossible. There was no association between CSF bupivacaine concentration and spinal block level, and CSF bupivacaine concentrations for the same spinal block level differed between patients by six-fold.
Conclusions: There is a large variability of CSF bupivacaine concentrations in patients with an adequate level of spinal anaesthesia.
Keywords: anaesthetic techniques; anaesthetics local, bupivacaine; cerebrospinal fluid; spinal chord, sensory block
3 Present address: Department of Anaesthesia, Zollikerberg Hospital, Trichtenhauserstrasse 20, CH-8125 Zollikerberg, Switzerland
This article is accompanied by Editorial I.
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