Isobaric bupivacaine for spinal anaesthesia in acute war injuries

Twenty nine patients with acute war injuries of the lower limbs or perineum were anaesthetised with intrathecal bupivacaine. Eleven patients (38%) were shocked on arrival with systolic arterial blood pressures less than 90 mmHg; in three the blood pressure was unrecordable . All patients were resuscitated and ready for surgery within 30 minutes of arrival at the field hospital. Hypotension occurred two minutes after injection of bupivacaine in three of the eleven shocked patients, but was corrected with fluids and metaraminol without difficulty. Patients with a fever were found to be less likely to develop hypotension. The early onset of hypotension and the necessity for a head-down tilt gives bupivacaine a significant advantage over hyperbaric agents, and the technique can be recommended.