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LETTER TO THE EDITOR

Spinal Block with 1.5 mg Hyperbaric Bupivacaine: Not Successful for Everyone

Assistant Professor of Anesthesiology; Mount Sinai School of Medicine; Elmhurst Hospital Center; New York

In Response:

There are several differences between Carron et al.'s (1) study of small-dose bupivacaine and ours that might account, at least in part, for the different results. First, Carron et al. (1) used isobaric 0.5% bupivacaine, whereas we used hyperbaric 0.75% bupivacaine. Second, there is no mention of patient position, rate of injection, and duration of patient position before final positioning for surgery.

The essence of the spinal perianal technique (2) is to direct a small bolus of bupivacaine, towards its target, S4-5 and coccygeal nerve roots, by lodging at the lower end of the dural sac. Success of the spinal perianal anesthesia technique depends on subtle use of many factors such as bupivacaine concentration, higher gradient, baricity, sitting position, gravity effect, direction of needle orifice, slow rate of injection, no barbatage to preserve the integrity of the bupivacaine bolus, and time-dependency integral to the technique before final patient positioning.

Further work may be needed to assess the advantages and limitations of this technique.

REFERENCES

1. Carron M, Freo U, Veronese S, Innocente F, Ori C. Spinal block with 1.5 mg hyperbaric bupivacaine: not successful for everyone. Anesth Analg 2007;105:1515–6[Free Full Text]
2. Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT. Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg 2007;104:1594–6[Abstract/Free Full Text]

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