[Continuous spinal anesthesia using bupivacaine. Report of experiences].

Abstract

Continuous spinal anesthesia has not yet found general acceptance, although it is a simple and efficient method. Its main advantage is allowing a reliable block to be built up step by step while carefully monitoring the cardiovascular changes. Postspinal headache can be avoided by restricting the use of elderly patients. At our institution, continuous spinal anesthesia has been administered to geriatric high-risk patients for more than 6 years. We report our experience from the year 1986. PATIENTS AND METHODS. Over a 1-year period continuous spinal anesthesia was used for 157 patients with a mean age of 80.4 years (Fig. 1). Of these patients 111 (70.7%) were classified as ASA 3-5 (Fig. 2). In 2 cases a myocardial infarction dated back only 4 and 11 days. The most common indications for surgery were hip fractures (97, 61.8%) and vascular occlusions (37, 23.6%). An 18G Tuohy needle was used for lumbar puncture. The catheter (Portex minipack) was advanced 3-6 cm into the subarachnoid space. Plain bupivacaine 0.5% was injected in small increments until the desired block level was achieved. The catheters were removed immediately after surgery. RESULTS. In 155 of 157 cases surgery was completed under regional anesthesia. Two patients had to be intubated intraoperatively (1 unexpected laparatomy during vascular surgery, 1 with insufficient block for lumbar sympathectomy). The main technical problem was impossibility to advance the catheter into the subarachnoid space despite free flow of CSF (5 cases). For these patients single-shot spinal (4 cases) or epidural anesthesia (1 case) was used.(ABSTRACT TRUNCATED AT 250 WORDS)