Letters to the Editor: Letters & Announcements
I would like to thank Dr. Zeidan for his comments regarding the case we presented (1). The case cited with bupivacaine and fentanyl does indeed show an extremely long block (2); however it is not uncommon for bupivacaine spinals to last a substantial amount of time, which may delay discharge of day surgery patients (3). The addition of fentanyl would both increase the intensity of the spinal block as well as affect to some extent its duration, as Dr. Zeidan suggested. However, there has not been a case reported with spinal ropivacaine, with or without the addition of fentanyl, that has lasted such an extended period of time. This patient had received an earlier spinal anesthetic with bupivacaine and fentanyl without incident, so the only difference in her case was the use of ropivacaine as opposed to bupivacaine. As to the suggestion of adding fentanyl to the title of the case, that would also be reasonable.
M. K. Panni, MD, PhD
Department of Anesthesiology
Duke University Medical Center
1. James ML, Panni MK. Extremely prolonged unilateral block (20 hours) with spinal ropivacaine used for cervical cerclage placement. Anesth Analg 2005;100:897–8.
2. Arndt JA, Downey T. Exceptionally prolonged anesthesia after a small dose of intrathecal bupivacaine. Anesthesiology 2002;97:1042.
3. Erhan E, Ugur G, Anadolu O, et al. General anaesthesia or spinal anaesthesia for outpatient urological surgery. Eur J Anaesthesiol 2003;20:647–52.