Influence of Obesity on the Spread of Spinal Analgesia After Injection of Plain 0.5% Bupivacaine at the L3–4 or L4–5 Interspace

Abstract

Spinal anaesthesia was compared in 40 obese patients (increased body mass index (BMI] and 40 patients with normal BMI when 3 ml of plain 0.5% bupivacaine was injected at either the L3-4 or L4-5 interspace. More extensive cephalad spread of sensory block was achieved in patients with increased BMI compared with patients with normal BMI after injection at both L3-4 and L4-5 (P less than 0.05). The use of the L3-4 interspace instead of L4-5 resulted in a higher mean spread of block in patients with both increased (T4 vs T8) or normal (T9 vs T11) BMI (P less than 0.05). The interindividual variability of the blocks was relatively small in patients with normal BMI injected at L4-5, compared with the three other groups (normal BMI injected at L3-4, increased BMI injected at L3-4 and L4-5). Good anaesthesia was produced in all patients for orthopaedic surgery of the lower extremity. In an obese patient it is recommended that plain bupivacaine be administered at L4-5 instead of L3-4 when extensive spread of the block is to be avoided.

Body habitus does not influence spread of sensory blockade after the intrathecal injection of a hypobaric solution in term parturients

“…Similar to the results of the current study, several studies in non-pregnant adults found increased BMI was associated with a higher cephalad sensory level when local anesthetic solutions were administered at doses necessary for surgical anesthesia. [7][8][9][10][11] There was a large variability in cephalad sensory levels following intrathecal injection of a hypobaric solution in the current study, similar to studies of isobaric and hyperbaric solutions. There have been several small series of case reports in which parturients had sensory blockade of cranial nerves after initiation of CSE analgesia.…”

Comparison of Two Different Doses of Intrathecal Levobupivacaine for Transurethral Endoscopic Surgery

“…These outcomes indicated that both of the levobupivacaine doses that were used in a geriatric patient population were safe. When the literature was evaluated, height and body weight were among the other demographic features that affect spinal anesthesia level [6,18]. In our study, the groups were similar in all of these factors.…”

“…Levobupivacaine is an S(-) enantiomer of bupivacaine and a long-acting local anesthetic with an amide structure [5,6]. Levobupivacaine is available in isobaric form in 0.25%, 0.5% and 0.75% concentrations.…”

Anaesthesia for the morbidly obese patient

“…Dose requirements for operative SABs are 75-80% of normals $7-59 but are somewhat more variable than normal. 59 In fit MO patients SAB to T5 produces little change from baseline in respiratory volumes 6~ and blood gases. 6~ However, if the block extends above T5 there is a risk of respiratory compromise, especially in those patients with preexisting respiratory disease.…”