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Kokki M, Heikkinen M, Kumpulainen E, et al. Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block. Anesth Pain Med. 2016;6(3):e33815doi: 10.5812/aapm.33815.
Kokki, M., Heikkinen, M., Kumpulainen, E., Vähäoja, A., & Kokki, H. (2016). Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block. Anesthesiology and pain medicine, 6(3), e33815. https://doi.org/10.5812/aapm.33815
Kokki, Merja, et al. "Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block." Anesthesiology and pain medicine vol. 6,3 (2016): e33815. doi: https://doi.org/10.5812/aapm.33815
Kokki M, Heikkinen M, Kumpulainen E, Vähäoja A, Kokki H. Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block. Anesth Pain Med. 2016 Apr 27;6(3):e33815. doi: 10.5812/aapm.33815. eCollection 2016 Jun. PMID: 27642576; PMCID: PMC5018151.
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Anesth Pain Med. 2016 Apr 27;6(3):e33815. doi: 10.5812/aapm.33815. eCollection 2016 Jun.

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

Anesthesiology and pain medicine

Merja Kokki, Marja Heikkinen, Elina Kumpulainen, Aura Vähäoja, Hannu Kokki

Affiliations

  1. Department of Anesthesia and Operative Services, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland; Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
  2. Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
  3. Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.

PMID: 27642576 PMCID: PMC5018151 DOI: 10.5812/aapm.33815

Abstract

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.

Keywords: Adolescent; Anesthesia; Cerebrospinal Fluid; Child; Levobupivacaine; Postdural Puncture Headache; Preschool; Spinal

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