title: [Spinal anesthesia with bupivacaine for a patient with a history of severe leg pain after intrathecal dibucaine].
abstract: An 87-year-old man was scheduled for the 11th transurethral bladder tumor resection (TURBT). He had a history of non-active syphilis for 21 years, diabetes mellitus for 7 years, and severe emphysema. Preoperative physical examination of the lower extremities, revealed loss of knee-jerk reflex, and loss of vibratory and proprioceptive perception. Four years previously, he underwent TURBT twice under spinal anesthesia with dibucaine, which caused severe leg pain during anesthesia. Therefore, subsequent TURBTs (eight times) were performed under general anesthesia with tracheal intubation, which frequently caused postoperative respiratory distress. Recently, bupivacaine, less neurotoxic than dibucaine, was on the market in Japan for use in spinal anesthesia. Therefore we planned spinal anesthesia using 0.5% bupivacaine, 2.0 ml. This time, he did not complain of leg pain during anesthesia, and postoperative conditions were satisfactory. We can conclude that bupivacaine is very useful for spinal anesthesia especially in patients with a history of leg pain by spinal anesthesia with dibucaine.
authors.affiliation: Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki 710-8602.
authors.forename: Takanao
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamura
authors.forename: Yumika
authors.initials: Y
authors.lastname: Koizumi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Naoki
authors.initials: N
authors.lastname: Masuda
authors.forename: Akitomo
authors.initials: A
authors.lastname: Yonei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine; D003992:Dibucaine / Q000009:adverse effects*; D006801:Humans; D007866:Leg; D008297:Male; D010146:Pain / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D003992:Dibucaine; D002045:Bupivacaine