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LETTER TO THE EDITOR

Minimum Effective Dose of Bupivacaine Required for Transurethral Procedures Remains Uncertain

Department of Anesthesiology, Critical Care and Pain Management; Meir Medical Center; Kfar Sava, Israel; Fredman.Brian{at}clalit.org.il

In Response:

As Dutta (1) points out, the density of a solution may influence intrathecal drug spread. However, our study (2) was designed to mirror routine practice. Although it is quite possible that the drug dilution process resulted in a small difference in density of the injectate, our aim was to clinically assess the analgesic efficacy of different bupivacaine dosages among elderly people undergoing short transurethral procedures. The table that the authors (1) attach illustrates that, in fact, the bupivacaine concentration in the final solution decreased in a linear fashion. Therefore, given the limitations of clinical practice, our study design was adequate to achieve its aim.

Because the results of this study were published in the Journal as a Brief Communication, a detailed debate on the effect of density on intrathecal local anesthetic spread was not included in the text.

REFERENCES

1. Dutta A, Taneja A. Minimum effective dose of bupivacaine required for transurethral procedures remains uncertain. Anesth Analg 2007;105:1170[Free Full Text]
2. Zohar E, Noga Y, Rislick U, Leibovitch I, Fredman B. Intrathecal anesthesia for elderly patients undergoing short transurethral procedures: a dose-finding study. Anesth Analg 2007;104:552–4[Abstract/Free Full Text]

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