Spinal anesthesia in children: no longer an anathema!
BACKGROUND
Spinal anesthesia is underutilized for surgery in children in Nigeria. Until recently, only caudal and general anesthesia are employed in the pediatric age group, and the thought of spinal anesthesia was an anathema. This study evaluated cardiovascular changes, duration of spinal block, the length of surgery, length of spinal needle to establish lumbar puncture, and the incidence of complications associated with this procedure.


METHODS
Thirty-two children ASA 1 and 2 between the ages of 2 and 12 had spinal block from August 1, 2008 to February 28, 2010 for orthopedic and plastic surgical procedures. Spinal block was carried out at L5/S1 interspace, and the dose of bupivacaine was 0.5 mg·kg(-1).


RESULTS
Satisfactory surgical anesthesia was achieved in 31 of 32 children. There was no sensory or motor block within 10 min in one child, despite an easy lumbar puncture necessitating the use of general anesthesia. No patient showed oxygen desaturation, bradycardia, or hypotension. Two (6.5%) children aged 5 and 8 reported mild, position-dependent headaches, 3 (9.7%) had nausea and vomiting, and 5 (16.1%) had postspinal shivering. There was a positive correlation between the size of the child and the needle length to establish spinal anesthesia (r = 0.7, P = 0.0001).


CONCLUSIONS
This study demonstrates that spinal anesthesia in children causes minimal hemodynamic disruption and therefore is a safe technique for lower extremity surgeries. This technique that hitherto has not been popular with children in our environment has been found to be safe and equally effective.
Rukewe
Ambrose
A
Department of Anesthesiology, University College Hospital, Ibadan, Nigeria. ambyrukewe@gmail.com
Alonge
Temitope
T
Fatiregun
Akinola
A
D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001835:Body Weight; D002045:Bupivacaine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D035002:Lower Extremity / Q000601:surgery; D008297:Male; D009339:Needles; D009407:Nerve Block; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D012768:Shivering; D013129:Spinal Puncture
D000779:Anesthetics, Local; D002045:Bupivacaine