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Title: Spinal anaesthesia : an appraisal of the effects of hyperbaric bupivacaine
Author: Chambers, W. A.
Awarding Body: University of Aberdeen
Current Institution: University of Aberdeen
Date of Award: 1981
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The use of spinal anaesthesia has increased in recent years, probably because of the steadily accumulating evidence of its beneficial effects in certain specific situations. However, opinions vary on the relative importance of the various factors which affect the spread of local anaesthetic solutions in the subarachnoid space. Many authorities have based their opinions on clinical impressions rather than on the results of controlled trials. Despite the large number of local anaesthetic agents which have been administered intrathecally, few are suitable for use today. Neither of the agents currently available in this country is ideal and there is a need for another agent. Bupivacaine has been widely used intrathecally in an isobaric solution but little is known about its properties when administered in hyperbaric solution. Clinical studies have been carried out on 140 patients to assess the effects of varying the baricity of the solution used, the dose and volume administered, the addition of vasoconstrictors and the rate of injection. A solution of 0.5% bupivacaine in 8% dextrose is a suitable hyperbaric solution for intrathecal use and consistently produces good spinal nerve block. The use of 0.75% bupivacaine in 8% dextrose does not confer any advantage, the addition of vasoconstrictors cannot be relied upon to produce a significant increase in duration in individual cases and varying the rate of injection does not appear to have any significant effect. 0.5% bupivacaine in 8% dextrose would be a valuable addition to those agents currently available for intrathecal use in this country. Clinical studies with it have demonstrated that some of the opinions on the factors which affect the spread of local anaesthetic solutions in the subarachnoid space and the pattern of the resulting sensory loss are incorrect.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available