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  1. Fulltext Spinal analgesia and headache at Penang General Hospital
    Inbasegaram K, Yong BH
    Med J Malaysia, 1985 Sep;40(3):233-8.
    PMID: 3842718
    One hundred (100) consecutive patients who underwent spinal analgesia for surgical and orthopaedic operations were studied. Postural headache occurred in 9% of patients, the majority in those cases where large bore (l8G to 21G) needless were used. No other neurological complications were encountered. Conservative measures provided some relief of the headache. Epidural blood patch was found to be effective.
    Matched MeSH terms: Anesthesia, Spinal/adverse effects*
  2. Fulltext Comparison between preloading with 10 ml/kg and 20 ml/kg of Ringer's lactate in preventing hypotension during spinal anaesthesia for caesarean section
    Muzlifah KB, Choy YC
    Med J Malaysia, 2009 Jun;64(2):114-7.
    PMID: 20058569 MyJurnal
    This prospective, randomized, study was designed to compare the effect of two different preloading volumes of Ringer's lactate for prevention of maternal hypotension induced by spinal anaesthesia for Caesarean section. Eighty ASA I or II obstetric patients were randomized to two groups. Group 1 (n = 40) received 20 ml/kg of Ringer's lactate and Group 2 (n = 40) 10 ml/kg of Ringer's lactate over 20 minutes before spinal anaesthesia. The lowest mean arterial pressure (MAP) for both groups were recorded at 15 minutes after giving spinal anaesthesia, This difference in the drop of MAP from base-line at 15 minutes (mean decrease of 12.5 mmHg from baseline), between preloading with 10 ml/kg and 20 ml/kg of Ringer's was statistically significant. Twelve patients from Group 1 required bolus doses of ephedrine and 15% of these needed additional crystalloid whereas two patients from Group 2 needed ephedrine boluses and 22% of these required additional crystalloid. The difference in frequency of requirement for treatment of hypotension was not statistically significant. There were five patients in Group 1 and six patients in Group 2 who experienced nausea and vomiting, the frequency of occurrence did not show any statistically significant difference between the two groups. In conclusion, for prevention of hypotension during spinal anaesthesia for Caesarean section, infusing 20 ml/kg or 10 ml/kg of Ringer's Lactate gave similar results and we do not recommend the use of a larger volume of crystalloid for preloading before spinal anaesthesia.
    Matched MeSH terms: Anesthesia, Spinal/adverse effects*
  3. Loss of consciousness following spinal anaesthesia for caesarean section
    Chan YK, Gopinathan R, Rajendram R
    Br J Anaesth, 2000 Sep;85(3):474-6.
    PMID: 11103195
    A healthy parturient under spinal anaesthesia for Caesarean section lost consciousness for an hour, 20 min after the intrathecal injection of 2 ml of 0.5% heavy bupivacaine. The patient was haemodynamically stable before losing consciousness. The differential diagnosis is discussed.
    Matched MeSH terms: Anesthesia, Spinal/adverse effects*
  4. Fulltext Incidence of postdural puncture headache. A prospective study of 101 spinal anaesthetics in orthopaedic patients
    Chan L, Delilkan AE
    Med J Malaysia, 1992 Mar;47(1):20-6.
    PMID: 1387444
    Spinal anaesthesia was performed on 101 patients with a 25-Gauge (0.52 mm) needle. We found a 13.9% overall incidence of postdural puncture headache (PDPH) in an orthopaedic population whose mean age was 33.6 years. This incidence is too high and an alternative technique may be needed.
    Matched MeSH terms: Anesthesia, Spinal/adverse effects*
  5. Fulltext Inadvertent injection of adrenaline into subarachnoid space--a case report
    Mustafa WNA, Mohandas K
    Med J Malaysia, 1982 Jun;37(2):108-9.
    PMID: 7132830
    A local anaesthetic agent with adrenalin meant for infiltration block was inadvertently given into spinal canal without any serious sequelae. The consequences of adrenalin in the subarachnoid space are discussed. Measures to prevent such accidents are suggested.
    Matched MeSH terms: Anesthesia, Spinal/adverse effects*
  6. Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study
    Chen CK, Lau FC, Lee WG, Phui VE
    J Clin Anesth, 2016 Sep;33:75-80.
    PMID: 27555137 DOI: 10.1016/j.jclinane.2016.03.007
    STUDY OBJECTIVES: To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA).

    DESIGN: Retrospective cohort study.

    SETTING: Operation theater with postoperative inpatient follow-up.

    PATIENTS: The medical records of 315 patients who underwent sequential bilateral TKA were reviewed.

    INTERVENTIONS: Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia.

    MEASUREMENTS: The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay.

    MAIN RESULTS: One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B.

    CONCLUSION: Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA.

    Matched MeSH terms: Anesthesia, Spinal/adverse effects
  7. Injection speed of spinal anaesthesia for Caesarean delivery in Asian women and the incidence of hypotension: A randomised controlled trial
    Chiang CF, Hasan MS, Tham SW, Sundaraj S, Faris A, Ganason N
    J Clin Anesth, 2017 Jun;39:82-86.
    PMID: 28494915 DOI: 10.1016/j.jclinane.2017.03.025
    STUDY OBJECTIVE: The purpose of this investigation was to determine if a slower speed of spinal anaesthesia injection would reduce the incidence of hypotension.

    STUDY DESIGN: Randomised controlled trial.

    SETTING: Tertiary level hospital in Malaysia.

    PATIENTS: 77 patients undergoing elective Caesarean delivery.

    INTERVENTION: Differing speeds of spinal injection.

    MEASUREMENTS: Systolic blood pressure was assessed every minute for the first 10min and incidence of hypotension (reduction in blood pressure of >30% of baseline) was recorded. The use of vasopressor and occurrence of nausea/vomiting were also recorded.

    MAIN RESULTS: 36 patients in SLOW group and 41 patients in FAST group were recruited into the study. There was no significant difference in blood pressure drop of >30% (p=0.497) between the two groups. There was no difference in the amount of vasopressor used and incidence of nausea/vomiting in both groups.

    CONCLUSION: In our study population, there was no difference in incidence of hypotension and nausea/vomiting when spinal injection time is prolonged beyond 15s to 60s.

    TRIAL REGISTRATION: ClinicalTrials.govNCT02275897. Registered on 15 October 2014.

    Matched MeSH terms: Anesthesia, Spinal/adverse effects
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