ABSTRACT
To recognise and manage the adverse effects of spinal diamorphine and bupivacaine. Diamorphine is used rather than morphine because, in the UK, it is widely available in a form that is free of preservatives or additives. The commonest drugs to use are diamorphine and bupivacaine, often together. Antibacterial: Surprisingly, some work in Sweden has shown that bupivacaine is itself antibacterial, thereby reducing the risk of infection if it is used. Low blood pressure: Bupivacaine does this by blocking the sympathetic nerves, causing blood vessels to dilate which drops the blood pressure. Slow heart rate: This is seen in epidural administrations if the bupivacaine has been injected into a blood vessel in the epidural space – the effect is due to a direct effect on the heart. This is very unusual with intrathecal spinals.
