Epidural anesthesia with 0.5% bupivacaine: influence of age on sensory and motor blockade.
To determine the influence of age on epidural blockade, 10 elderly male patients (mean age, 73 yr) and 11 young male volunteers (mean age, 25 yr) received epidural anesthesia with 20 mL of 0.5% bupivacaine with epinephrine at the L2-3 interspace. Median cephalad analgesia level (pinprick) was T-4 in the elderly and T-10 in the young subjects (P less than 0.01). The duration of analgesia at the L-1 to S-3 segments was about 60 min shorter in the older patients than in the young volunteers (P less than 0.05). Motor blockade was evaluated quantitatively by isometric muscle force measurements in the lower extremities and by electromyographic recordings from the abdominal and quadriceps muscles. Motor blockade in the lower extremities was also assessed qualitatively by the Bromage scale. The intensity of motor blockade was not influenced by age. The mean duration of maximal motor blockade of the lower abdominal muscles was 69 min in elderly patients and 140 min in young subjects (P less than 0.05). The corresponding mean duration in the lower extremities was approximately 1.5 h in the older patients and 3 h in the young subjects (P less than 0.01). The elderly patients could be mobilized 2 h earlier than the young volunteers. Duration of Bromage grade 1 was about 1.5 h shorter in the elderly than in the young subjects (P less than 0.01). Not until 1.5-2 h after attainment of Bromage grade 0 was the muscle force in the lower extremities restored to 90% of baseline value. The authors conclude that cephalad spread was more extensive and duration of epidural blockade was shorter in elderly patients versus younger volunteers.
Nydahl
P A
PA
Department of Anesthesiology, Orebro Medical Center Hospital, Sweden.
Philipson
L
L
Axelsson
K
K
Johansson
J E
JE
D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D000767:Anesthesia, Epidural; D002045:Bupivacaine; D004576:Electromyography; D006801:Humans; D008297:Male; D009407:Nerve Block; D009469:Neuromuscular Junction / Q000502:physiology*; D010146:Pain; D012684:Sensory Thresholds / Q000502:physiology*
D002045:Bupivacaine