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Effect of epidurally administered bupivacaine on atracurium‐induced neuromuscular blockade
Author(s) -
Toft P.,
Nielsen H. Kirkegaard,
Severinsen I.,
HelboHansen H. S.
Publication year - 1990
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1990.tb03165.x
Subject(s) - medicine , neuromuscular blockade , bupivacaine , anesthesia , neostigmine , blockade , neuromuscular transmission , neuromuscular monitoring , fentanyl , midazolam , ulnar nerve , adductor pollicis muscle , atracurium besilate , edrophonium , surgery , sedation , receptor , elbow
The effect of epidurally administered bupivacaine on duration, intensity and reversal characteristics of atracurium‐induced neuromuscular blockade was studied in 30 healthy patients anaesthetized with thiopentone, fentanyl, midazolam and nitrous oxide. Fifteen patients received, in addition, epidural anaesthesia with bupivacaine. The remaining patients served as controls. The ulnar nerve was stimulated at the wrist and the evoked twitch response from the adductor pollicis was measured with a force displacement transducer. Neuromuscular blockade was induced with atracurium 0.5 mg i.v. and maintained with repeated doses of atracurium 0.15 mg/kg whenever the twitch height had recovered to 15% of the initial twitch height. After operation, the neuromuscular blockade was reversed with neostigmine when the twitch height had recovered to 15%. In the epidural group the clinical duration of neuromuscular blockade, time until first response to train‐of‐four (TOF) and reversal time were all significantly prolonged ( P <0.05). Post‐tetanic count (PTC) after 20 min was also significantly lower in the epidural group ( P <0.05). It is therefore concluded that epidurally administered bupivacaine prolongs atracurium‐induced neuromuscular blockade. The clinical implication of the modest prolongation is, however, limited.