title: Total spinal anaesthesia following caudal block with bupivacaine and buprenorphine.
abstract: This is a case report of an 18-month-old 10 kg child who presented for emergency repair of a recurrent diaphragmatic hernia with a history of craniofacial dystosis and was given a caudal block postoperatively with a combination of 4 ml of 0.5% bupivacaine and 2.5 micrograms.kg-1 buprenorphine made up to a total volume of 10 ml. An inadvertent dural puncture occurred resulting in total spinal block which was managed symptomatically. Block regression started one h later when the respiratory movements became noticeable. Eye opening and hand movements returned 3 h later. The patient's exposure to a large intrathecal dose of buprenorphine did not lead to prolonged respiratory depression. The possibility of a midbrain insult due to a sudden rise in intracranial pressure is also discussed.
authors.affiliation: Department of Anaesthesia, Aga Khan University Hospital & Medical College, Karachi, Pakistan.
authors.forename: G
authors.initials: G
authors.lastname: Afshan
authors.forename: F A
authors.initials: FA
authors.lastname: Khan
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects; D004388:Dura Mater; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D007223:Infant; D007278:Injections, Spinal / Q000009:adverse effects; D008297:Male; D009407:Nerve Block / Q000009:adverse effects; D011677:Punctures / Q000009:adverse effects; D012008:Recurrence; D013116:Spinal Cord / Q000187:drug effects
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002047:Buprenorphine; D002045:Bupivacaine