Spinal anesthesia in children with isobaric local anesthetics: report on 307 patients under 13 years of age

Abstract

Background: Spinal anesthesia in expert hands is an excellent method for children for appropriate surgery. The aim of this study was to evaluate the effects of spinal anesthesia with isobaric solutions in 307 consecutive cases from May 2001 to August 2002.

Methods: In this prospective study, 307 patients from 0 to 12 years of age were scheduled for spinal anesthesia with enantiomeric mixture of bupivacaine (S75 : 25R) 0.5% or racemic bupivacaine 0.5% or lidocaine 2% without glucose, for surgery compatible with the technique. The following were assessed: latency of analgesia, motor block, maximum length and duration of sensory blockade, cardiovascular changes, incidence of headache or transient neurological symptoms and cost.

Results: The onset of sensory block occurred at 2.36 +/- 0.95 min. Duration of surgery was 1.29 +/- 0.83 h and the duration of stay in the postanesthesia care unit was 39.72 +/- 26.84 min. The highest level of analgesia ranged from T(9) to T(4) (mean T(6)). Onset of motor block was <2 min in all children and each had a modified Bromage score of 3 at the beginning of the surgery. At the end of the surgery 9% had score 3, 16%, score 2, 46%, score 1 and 29%, zero. Seventy five percent of all patients recovered from motor block 1 or zero at the end of the surgery. Patients older than 1 year were able to walk in 3.79 +/- 0.73 h. There was no case of oxygen desaturation. Hypotension and bradycardia occurred in one patient. Spinal anesthesia failed in five patients. Three children developed postdural puncture headache (PDPH), the youngest aged 2 years. PDPH in all three was mild or moderate. Transient radicular symptoms were not observed. The final cost of the spinal anesthesia was R dollars 49.00 compared with a mean cost of general anesthesia of R dollars 105.00.

Conclusions: Spinal anesthesia continues to gain acceptance as an alternative to general anesthesia in children. There has also been an increased use of spinal anesthesia for other surgical procedures including lower extremity orthopedic procedures as well as specific surgery procedures above the umbilicus and in patients past the neonatal period. Spinal anesthesia in children is a special method suitable for use only by anesthesiologists, expert in administering spinal anesthesia for adults. It was 54% less than the cost of general anesthesia.