title: Levobupivacaine for Spinal Anesthesia in Children: Cerebrospinal Fluid Aspiration Before the Injection Does not Affect the Spread or Duration of the Sensory Block.
abstract: BACKGROUND
  Several factors are thought to affect the spread and duration of spinal anesthesia (SA) in adults. These include the volume of cerebrospinal fluid (CSF) in the lumbar spinal canal, which has a negative correlation with both the spread and duration of the sensory block.
  
  
  OBJECTIVE
  We evaluated whether CSF aspiration before an injection of levobupivacaine affected the spread or duration of SA in children.
  
  
  METHODS
  SA was induced by levobupivacaine (5 mg/mL, 0.25 - 0.5 mg/kg) in 186 children aged 10 months to 18 years (mean of 7.5 years). Two groups were analyzed prospectively: 93 children from which 1 - 3 mL of CSF (CSF-aspiration group) was aspirated before the injection of levobupivacaine to induce SA and 93 children from which no CSF was aspirated (no-CSF-aspiration group) prior to the injection of levobupivacaine. The main outcome measure was regression of the sensory block below T10, cephalic spread of the block, and postpuncture complications after SA.
  
  
  RESULTS
  There were no between-group differences in the time to regression of the block below T10 or in the cephalic spread of the sensory block: 94 (27) minutes and T4.4 (SD 2.2) in the CSF-aspiration group, respectively, vs. 97 (29) minutes and T4.3 (1.8), respectively, in the no-CSF-aspiration group. Position-dependent headaches developed in 4 of 91 children in the CSF-aspiration group and 5 of 86 children in the no-CSF-aspiration group, but no epidural blood patches were required.
  
  
  CONCLUSIONS
  The aspiration of 1 - 3 mL of CSF before an injection of levobupivacaine did not seem to affect the spread and duration of the sensory block or postpuncture complications in children following SA.
authors.affiliation: Department of Anesthesia and Operative Services, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland; Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Kokki
authors.affiliation: Department of Pediatric Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Heikkinen
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Kumpulainen
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Aura
authors.initials: A
authors.lastname: Vähäoja
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
keywords: Adolescent; Anesthesia; Cerebrospinal Fluid; Child; Levobupivacaine; Postdural Puncture Headache; Preschool; Spinal