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Effect of Intrathecal Bupivacaine on Somatosensory Evoked Potentials following Dermatomal Stimulation

Received from the Departments of Anesthesiology and Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark and the Department of Clinical Neurophysiology, Aalborg Hospital, DK-9000 Aalborg, Denmark.

Abstract

The effect of spinal anesthesia with 3.6 ± 0.1 ml (mean ± SEM) of 0.5% bupivacaine on early (<150 msec) somatosensory evoked potentials (SEPs) with electrical stimulation of the L₁ and S₁ dermatomes was examined in 12 patients. The mean level of sensory analgesia (pinprick) was T_{8.9 ± 1.0} (± SEM) and the mean degree of motor blockade was 1.3 ± 0.1 (Bromage scale). Intrathecal bupivacaine significantly (P < 0.05) decreased the amplitude of all SEP components after stimulation of the L₁ dermatome and most components during stimulation of the S₁ dermatome. Intrathecal bupivacaine also increased the latency of SEPs (P < 0.05) of both dermatomes. The L₁ SEP disappeared in 7 and the S₁ SEPS in 5 of the 12 patients during neural blockade. In three patients the SEPs disappeared at both locations. Sensory thresholds increased significantly during blockade. We found no correlation between decrease of amplitude and degree of motor blockade or level of sensory analgesia. Thus, intrathecal plain bupivacaine has a strong depressant effect on the neural afferent transmission as assessed by SEPs. However, despite clinically effective blockade as assessed by pinprick and motor blockade nerve potentials after nociceptive stimulation within the area of sensory block were often able to pass to the cerebral cortex.

Key Words: ANESTHETIC TECHNIQUES—spinal • BRAIN—somatosensory evoked responses.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999