Yonsei Med J.  2009 Apr;50(2):252-256.

Spinal Anesthesia with Isobaric Tetracaine in Patients with Previous Lumbar Spinal Surgery

• Kim SH
• Jeon DH
• Chang CH
• Lee SJ
• Shin YS

Abstract

PURPOSE
Previous lumbar spinal surgery (PLSS) is not currently considered as a contraindication for regional anesthesia. However, there are still problems that make spinal anesthesia more difficult with a possibility of worsening the patient's back pain. Spinal anesthesia using combined spinal-epidural anesthesia (CSEA) in elderly patients with or without PLSS was investigated and the anesthetic characteristics, success rates, and possible complications were evaluated. MATERIALS AND METHODS: Fifty patients without PLSS (Control group) and 45 patients with PLSS (PLSS group) who were scheduled for total knee arthroplasty were studied prospectively. A CSEA was performed with patients in the left lateral position, and 10 mg of 0.5% isobaric tetracaine was injected through a 27 G spinal needle. An epidural catheter was then inserted for patient controlled analgesia. Successful spinal anesthesia was defined as adequate sensory block level more than T12. The number of skin punctures and the onset time were recorded, and maximal sensory block level (MSBL), time to 2-segment regression, success rate and complications were observed. RESULTS: The success rate of CSEA in Control group and PLSS group was 98.0%, and 93.3%, respectively. The median MSBL in PLSS group was higher than Control group [T4 (T2-L1) vs. T6 (T3-T12)] (p < 0.001). There was a significant difference in the number of patients who required ephedrine for the treatment of hypotension in PLSS group (p = 0.028). CONCLUSION: The success rate of CSEA in patients with PLSS was 93.3%, and patients experienced no significant neurological complications. The MSBL can be higher in PLSS group than Control group.

Keyword

Anesthetics local, tetracaine; anesthetic techniques, subarachnoid; surgery, spinal

MeSH Terms

Aged
Anesthesia, Spinal/*methods
Female
Humans
Lumbar Vertebrae/*surgery
Male
Middle Aged
Prospective Studies
Tetracaine/*administration & dosage

Figure

• 

  Fig. 1 Distribution of maximal sensory block level on the right and left in 2 groups. Horizontal lines represent median levels. MSBL on right, T4 (T3 - T12), is higher in PLSS group than in Control group, T6 (T2 - T12) (p < 0.001). MSBL on left, T4 (T3 - L1), is higher in PLSS group than in Control group, T6 (T2 - T12) (p < 0.001). Control group is defined as patients without previous lumbar spinal surgery. MSBL is defined as maximal sensory block level. PLSS group is defined as patients with previous lumbar spinal surgery. PLSS, previous lumbar spinal surgery.

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