title: The effect of age on retrieval of local anesthetic solution from the epidural space.
abstract: We conducted this prospective study to determine whether advancing age is correlated with retrieval of local anesthetic solution from the epidural space. Three hundred forty-six patients (ASA physical status I or II, 20-93 yrs of age, 177 female and 169 male patients) undergoing epidural anesthesia were enrolled. The epidural space was identified by a loss of resistance technique using air, and a catheter was introduced 3 cm. Three milliliters of 2% lidocaine with epinephrine was injected as a study dose by hand at a rate of 1 mL/s with the patient in the supine position. The syringe was immediately aspirated to retrieve the local anesthetic solution. A retrieved volume of 0.5 mL or more with a glucose concentration less than 6 mg/dL was defined as retrieval positive, and a volume of less than 0.5 mL was defined as retrieval negative. There was a significant correlation between age and retrieval volume among all the patients (Y = 0.008X-0.222, P < 0.0001) with a significant increase in the positive retrieval incidence and volume from the patients in their 50s (11%, 0.6 +/- 0.3 mL) to the patients in their 60s (26%, 1.0 +/- 0.6 mL) (P < 0.05 for both). The incidence of positive retrieval and the retrieval volume were greater in the patients in their 60s and older (30%, 1.1 +/- 0.63 mL) than in the younger than 60 (10%, 0.6 +/- 0.3 mL) (P < 0.0001 and P < 0.001). The glucose concentration was 2.3 +/- 1.2 mg/dL in the positive cases. We conclude that there is a weak positive correlation between age and the local anesthetic solution retrieved from the epidural space.
  
  
  CONCLUSIONS
  We conducted a study in 346 patients to determine whether advancing age could be correlated with retrieval of local anesthetic solution from the epidural space. We found a weak positive correlation between advanced age and the amount of solution retrievable from the epidural space. Further studies are required to determine whether this phenomenon may call for dose adjustments in patients aged more than 60 yrs.
authors.affiliation: Department of Anesthesia, Mito Saiseikai General Hospital, Ibaraki, Japan. QWP05622@niftyserve.or.jp
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: R
authors.initials: R
authors.lastname: Takeshima
authors.forename: N
authors.initials: N
authors.lastname: Asakura
authors.forename: M
authors.initials: M
authors.lastname: Kumagai
authors.forename: N
authors.initials: N
authors.lastname: Taguchi
authors.forename: T
authors.initials: T
authors.lastname: Satsumae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism*; D000767:Anesthesia, Epidural / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics*; D004824:Epidural Space / Q000378:metabolism; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012996:Solutions
chemical_list: D000779:Anesthetics, Local; D012996:Solutions; D008012:Lidocaine; D004837:Epinephrine