Correspondence  |   June 2003
Can't Blame Bupivacaine
Author Notes
  • Professor (Hon) Surgery/Anesthesia, University of South Carolina School of Medicine.
Article Information
Correspondence   |   June 2003
Can't Blame Bupivacaine
Anesthesiology 6 2003, Vol.98, 1523. doi:
Anesthesiology 6 2003, Vol.98, 1523. doi:
To the Editor:—
Arndt and Downey 1 vividly convey a physician's dismay when motor, sensory, and bladder function are agonizingly slow to return after uneventful spinal block. The delayed recovery pattern described here is not unlike that seen when a potent vasoconstrictor such as neosynephrine is added to the local anesthetic solution to prolong deliberately the duration of sensory blockade. Because the patient remained painfree, pharmacologic or mechanical cauda equinopathy, 2 fortunately, could be ruled out decisively in the differential diagnosis.
Although the authors postulate low spinal fluid volume as a contributing factor, that might be a rather slender straw to cling to in a healthy 20-yr-old young woman with freely aspirable spinal fluid. 3 Instead (because a vasoconstrictor wasn't used), the addition of fentanyl to intensify and prolong bupivacaine block did achieve its intended purpose—albeit as a statistical outlier well beyond the expected norm of 4 ± 2 h. 1 All told, this correspondent finds no compelling evidence to single out bupivacaine as the sole culprit for the protracted spinal analgesia. 4 That is to say, the letter's title “Exceptionally Prolonged Anesthesia after a Small Dose of Intrathecal Bupivacaine” falls short. Rather, the title should have read “Prolonged Analgesia after Intrathecal Bupivacaine plus  Fentanyl.”
Arndt JA, Downey T: Exceptionally prolonged anesthesia after a small dose of intrathecal bupivacaine (letter). A nesthesiology 2002; 97: 1042Arndt, JA Downey, T
de Jong RH: The intrathecal lidocaine enigma: on the brink of cauda equinopathy, Annual of Anesthetic Pharmacology. Edited by Hines R, Bowdle TA. Philadelphia, Saunders, 1999, pp 287–98
Carpenter RL, Hogan QH, Liu SS, Crane B, Moore J: Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. A nesthesiology 1998; 89: 24–29Carpenter, RL Hogan, QH Liu, SS Crane, B Moore, J
Horlocker TT, Wedel D: Neurologic complications of spinal and epidural anesthesia (review). Reg Anesth Pain Med 2000; 25: 83–98Horlocker, TT Wedel, D