Transient radicular irritation after bupivacaine spinal anesthesia

Transient radicular irritation (TRI) has been described to occur following spinal anesthesia with hyperbaric 5% lidocaine. The authors recently used only isobaric or hyperbaric 0.5% bupivacaine for spinal anesthesia. All patients who had spinal anesthesia for various kinds of surgery were interviewed after the operation to discover the possibility of TRI following bupivacaine spinal anesthesia.

The study included 226 patients. Isobaric 0.5% bupivacaine was given to 116 patients and hyperbaric 0.5% bupivacaine to 110. The local anesthetic was chosen according to the expected duration of surgery. All patients were interviewed by an anesthesiologist 24 hours after spinal anesthesia, and after 1 week the patients were asked to return a written questionnaire. If pain not associated with operation was noted, the patients were interviewed by phone.

One 48-year-old woman reported TRI after spinal anesthesia (saddle block) with hyperbaric 0.5% bupivacaine in the 24-hour interview. Her spinal anesthetic was performed in a sitting position and the anal surgery in a lithotomy position. In the 1-week questionnaire (response rate 92%), none of the other patients fulfilled our criteria for TRI.

In spite of one case of TRI, the authors consider bupivacaine to be safe for spinal anesthesia. The association of the sitting and lithotomy positions to the restricted distribution of hyperbaric solution and consequent TRI warrants further studies.