ANESTH ANALG LETTERS TO THE EDITOR 219

1996;82:214-22

References References
1. Koblin DD, Chortkoff BS, Laster MJ, et al. Polyhalogenated and perfluorinated com- 1. Welbom SG. The lithotomy position. Anaesthetic considerations. In: Martin JT, ed.
pounds that disobey the Meyer-Overton hypothesis. An&h Analg 1994;79:1043-8. Positioning in anesthesia and surgery. Philadelphia: WB Saunders, 1987;57-63.
2. Eckenhoff RG. Tests of anesthetic relevance [letter]. An&h Analg 1995;81:431-2. 2. Yadav SL, Singh U, Dureja Gl’, et al. Phenol blocks in the management of spastic
3. Eeer EI IL Koblin DD. Halsev Ml. Tests of anesthetic relevance lreolv
I, to letterl. An&h cerebral o&v. Indian I l’ediatr 1994:61:249-55.
A;alg 19$5;81:432. ’ ’ 3. Katz J, Fkld&an DJ, K&t L, Russ& AJ. Peripheral nerve blocks with dilute phenol
4. Liu J, Laster MJ, Koblin DD, et al. A cutoff in potency exists in the perfluoroalkanes. solution in the treatment of spasticity. Anesthesiology 1965;26:254.
An&h Analg 1994;79:238-44.

Propofol Induction Is More Effective Than

Patient Comfort: Spinal Versus Epidural Ondansetron in Prophylaxis of
Anesthesia for Cesarean Section Postoperative Nausea, but Not Vomiting
To the Editor: To the Editor:
We wish to add our experience to the views of Riley et al. (1). Given Hvarfner et al. (1) have recently concluded that propofol does not
that the patient herself is best able to quantify her degree of comfort, prevent vomiting induced by apomorphine, and that its antiemetic
we conducted a retrospective survey of 150 women who had un- effect depends largely on sedation.
dergone cesarean section under regional anesthesia. During emer- Postoperative nausea and vomiting are viewed as part of the same
gency procedures, the number of patients who described some process and mechanisms with regard to etiology. Although the mech-
degree of discomfort (mainly tugging/mild pain and nausea) was anisms of vomiting have been demonstrated, nausea is regarded as a
comparable between the group of women who received a spinal subjective complaint and criteria for measurement have not yet been
anesthetic (35%) and the group who received an epidural anesthetic established. Propofol has been studied in subhypnotic doses in suc-
(33%). By contrast, only 20% of the women had experienced any cessful prevention of nausea and vomiting (2). We have recently per-
discomfort during elective operation under spinal block. Eleven formed a double-blind, randomized, placebo-controlled, prospective
percent of patients questioned were in a position to compare pre- preliminary trial comparing the effects of propofol induced induction
vious cesarean sections under different anesthetic techniques. Only of anesthesia (single dose) and ondansetron on postoperative nausea
two women favored epidural over spinal anesthetic, both because of and vomiting separately (n = 15 in each group). Initial results indicated
the prolonged postoperative analgesia they had experienced. The that induction of anesthesia with propofol has a significant (P < 0.01
remainder preferred spinal anesthetic, largely because of the speed with analysis of variance) antinauseant effect during the first 24 h
of onset and return of motor power postoperatively. postoperatively, but that it does not exert any significant (P > 0.05)
In conclusion, Riley et al. may be pleased to learn that in addition effect on vomiting compared to the placebo. However, ondansetron
to costing less time and money, spinal anesthesia was also favored prevented vomiting significantly (P < 0.011, but patients experienced
by our patient population. nausea as much as the controls (P > 0.05). In the study by Hvarfner et
Marion Keohane, FFARCSI al. (l), vomiting was evaluated but there was no comment on nausea.
Department of Anesthesia There are some recent reports referring to nausea and vomiting as two
Altnageluin Area Hospital different entities (3). Therefore, we suggest that nausea and vomiting
Belfast, Northern Ireland should be studied and analyzed separately in terms of evaluating
Reference therapeutic approaches and in interpreting results.
1. Riley ET, Cohen SE, Macario A, et al. Spinal versus epidural anesthesia for cesa~ean Cigdem Tezcan, MD
section: a comparison of time efficiency, costs, charges, and complications. Anesth Yesim Ates, MD
Analg 1995;80:709-12.
Asli Donmez, MD
oya OZatamer, MD
Department ofAnesthesiology and Reanimation
Ankara University Medical Faculty
Blocks to Facilitate Lithotomy Positioning in Ankara, Turkey
Spastic Paraplegics References
1. Hvarfner A, Hammas 8, Thorn SE, Wattwil M. The influence of propofol on vomiting
To the Editor: induced by apomorphine. An&h Analg 1995;80:967-9.
2. Borgeat A, Wilder-Smith OHG, Saiah M, Rifat K. Subhypnotic doses of propofol
A 56-yr-old male patient with a 2-yr history of traumatic paraplegia possess direct anti-emetic properties. An&h Analg 1992;74:539-41.
(spinal fracture at second thoracic vertebra) was scheduled for a tran- 3. Dundee JW, McMillan CM. Anti-emetic or anti-nauseant of ondansetron. An&h Analg
1992;74:467-77.
surethral removal of a small vesical calculus under local anesthesia.
A lithotomy position was impossible due to spastic paraplegia
resulting in bilateral adductor spasm of the thigh and plantar flex-
ion of the foot. Bilateral obturator and posterior tibia1 blocks admin- Epidural Test Dosing
istered with a mixture of 0.5% bupivacaine (15 mL) and 2% lido-
Caine (10 mL) relieved the spasms. Flexion of thighs over the trunk To the Editor:
and dorsiflexion of the foot for placement in the stirrups was pos- Toledano et al. (1) are correct in questioning the appropriateness of routine
sible after 15 min. A proper lithotomy position is necessary in order epidural test dosing with epinephrine. Absent any comparison with con-
to accomplish many urologic and gynecologic procedures (1). A servative sequential dosing techniques, epinephrine testing of epiduml
combination of these blocks given with or without general anesthe- catheters has become “standard practice” (2). Although Schoenwald et al.
sia can be of great value in positioning patients with lower limb (3) observed no cardiac ischemia after giving 15 pg of epinephrine to 10
spasticity occurring due to a number of conditions. vascular surgery patients, it should be noted that Moore and Batra (4) did
A combination of these blocks with phenol has been used exten- induce electrocardiographic changes in their initial study of patients pre-
sively in our hospital to relieve spasticity on a long-term basis (2,3). medicated with narcotic and benzodiazepine (3). Of 175 individuals
These blocks have not been reported in literature for short-term use tested, 7 exhibited junctional rhythm; 3, premature ventricular contrac-
to facilitate positioning. Use of a nerve stimulator is advised for tions; 2, atrial tachycardia; 39, T-wave flattening 38 T-wave inversion; 4,
quick and accurate blocks. ST depression; and 1, bigeminy (4). Significant prolonged anxiety, cer-
V. Muralidhar, MD tainly an unwelcome preoperative side effect was also noted in volunteers
Department of Anaesthesiology tested (4).
All India Institute of Medical Sciences Case reports documenting failure of epidural catheter test
New Delhi 110029, India doses emphasize the importance of sound fundamental practice