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Correlation between glucose and bupivacaine levels in cerebrospinal fluid after spinal anesthesia: glycorrhachia as predictor for duration of sensory block
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Nuria Estañ-Capell
Published/Copyright:
February 12, 2010
Abstract
Background: Prediction of the duration of motor block after injection of a local anesthetic into cerebrospinal fluid (CSF) would be a very useful tool in clinical practice. However, previous attempts have not shown conclusive results. In this work, glycorrhachia is demonstrated to be an adequate predictive parameter after spinal anesthesia using 0.5% hyperbaric bupivacaine.
Methods: Two mL of local anesthetic through a continuous spinal catheter was administered to 40 patients. CSF was sampled at different time intervals from the onset of infusion to motor recovery. CSF bupivacaine concentrations were measured using chromatography. An automated analyzer was used for determining glycorrhachia in the same samples.
Results: For all patients, good correlation (r2>0.95, p<0.05) was obtained. From these results, it was possible to develop a general model which establishes the relationship between CSF glucose and bupivacaine concentrations (R2=0.987, p<0.05). Motor block is reached when CSF glucose concentration is about 245 mg/dL (13.5 mmol/L), which corresponds to 35 μg/mL of bupivacaine.
Conclusions: Glycorrhachia measured during surgical intervention in patients undergoing spinal anesthesia with hyperbaric bupivacaine provides a mechanism for predicting the duration of motor block in a rapid and simple manner.
Clin Chem Lab Med 2010;48:523–30.
Keywords: bupivacaine; cerebrospinal fluid; glycorrhachia; liquid chromatography; motor block duration; spinal anesthesia
Received: 2009-8-14
Accepted: 2009-11-23
Published Online: 2010-02-12
Published in Print: 2010-04-01
©2010 by Walter de Gruyter Berlin New York
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Keywords for this article
bupivacaine;
cerebrospinal fluid;
glycorrhachia;
liquid chromatography;
motor block duration;
spinal anesthesia
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- Reviews
- State of the art in therapeutic drug monitoring
- Decision criteria for rational selection of homogeneous genotyping platforms for pharmacogenomics testing in clinical diagnostics
- Reference Values and Biological Variations
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- Genotyping mitochondrial DNA single nucleotide polymorphisms by PCR ligase detection reactions
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