Predictors of successful neuraxial block: a prospective study

Filho, Getúlio Rodrigues de Oliveira; Gomes, H. P.; Fonseca, M. H. Z. da; Hoffman, Jonathan; Pederneiras, Sérgio Galluf; Garcia, Jorge Hamilton Soares

doi:10.1017/s0265021502000716

Cited by 133 publications

(69 citation statements)

References 12 publications

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“…With a first-attempt rate of 441/500 (88.2%), the practicability of the spinal anaesthesia was comparable or higher than that in studies of other authors comparing the success rates of experienced anaesthesiologists (Sprung: 87%, de Oliveira Filho: 71.4% [17,18] ). Side effects such as hypotension and bradycardia were lower than in the related literature [5,19] , probably due to the low dosage of heavy bupivacaine.…”

Section: Saddle Block Anaesthesia and Recoverymentioning

confidence: 56%

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner¹,

Janke²,

Limmer³

et al. 2009

Med Princ Pract

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Objectives: Additional intra-operative sedation may help improve acceptability and comfort of anaesthesia in patients undergoing minor anorectal (perianal) procedures under spinal saddle block. This observational study was done to determine which patients request sedatives and to what extent sedatives affect the patients’ recovery. Subjects and Methods: During a 6-month period, 500 patients undergoing minor perianal procedures received 1.0 ml hyperbaric bupivacaine (0.5%). On request, a light sedation with propofol in bolus application was provided. Patients were evaluated postoperatively using a standardized questionnaire about their perceptions before, during and 48 h after the administration of anaesthesia. Results: More female (91/143, 63.6%) than male (136/259, 52.5%) patients (p = 0.0312) received sedation. Patients with sedation were significantly younger (46.7 ± 13.8 vs. 50 ± 13.8 years, p = 0.0171) and had a lower body mass index (BMI; 25.6 ± 4.3 vs. 27.5 ± 5.1, p < 0.0001). Time to mobilization and first micturition was significantly longer in patients with sedation (4.8 vs. 4.4 h, p = 0.0194 and 5.8 vs. 5.4 h, p = 0.0188), which was associated with a higher incidence of nausea (7.5 vs. 1.7%, p = 0.0083). Conclusions: Female gender, younger age, lower body weight and lower BMI were associated with higher subjective requirements for sedation. The use of sedation showed prolongation of time to first mobilization and micturition and a higher incidence of nausea.

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Section: Saddle Block Anaesthesia and Recoverymentioning

confidence: 56%

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Schmittner¹,

Janke²,

Limmer³

et al. 2009

Med Princ Pract

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“…The extent of the complications vary, ranging from self-resolving events, such as postdural puncture headache [1], to severe incidents, such as permanent neurologic sequelae [2]. Some efforts have been made in order to predict the difficult neuraxial blockade for the purpose of minimizing the risk caused by traumatic placement of the needle [3,4]. However, no absolute predicting factors have been found so far in spite of the efforts.…”

Section: Introductionmentioning

confidence: 99%

Predicting the difficulty in performing a neuraxial blockade

Kim

Song

Kim

2011

Korean J Anesthesiol

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BackgroundTraumatic placement of a needle during a neuraxial blockade has been related to many complications such as postdural puncture headache, trauma to neural structures and even spinal hematoma, causing permanent neurologic deficits. Although efforts to minimize the complications caused by traumatic neuraxial blockade have been made, nothing was found to be clear. The authors investigated the predictors of difficult neuraxial blockade using the first puncture success and number of attempts as measures to assess the difficulty.MethodsIn this prospective observational study, 253 patients scheduled for elective surgery underwent spinal or epidural anesthesia. Patient data (age, sex, height, weight, body mass index, and quality of anatomical landmarks), the provider's level of experience, type of blockade (spinal or epidural), needle type/gauge and the distance from skin to subarachnoid or epidural space were recorded. Significant variables were first determined by Student's t-test and Pearson's chi square test and then logistic and Poisson regression tested the association of the first puncture success and number of attempts with the significant variables.ResultsThe provider's level of experience and the distance from skin to subarachnoid or epidural space were significant in logistic and Poisson regression. Body mass index was significant only in Poisson regression and the quality of anatomical landmarks was significant only in logistic regression.ConclusionsProvider's level of experience and the distance from skin to subarachnoid or epidural space influenced the difficulty in performing a neuraxial blockade.

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“…This might be caused by inadequate difference in lumbar vertebrae furtherance in both groups (15, 16). Many studies have found landmark identification to be one of the important factors for successful spinal anesthesia administration, although its accuracy in evaluating the required intervertebral gaps is poor (1, 4, 9, 25, 26). …”

Section: Discussionmentioning

confidence: 99%

“…Poor positioning may cause repeated spinal needle insertions and spinal needle-vertebrae bone contact, thus increasing the risk of back pain, post-dural puncture headache (PDPH), epidural hematoma, and neural trauma (9). …”

Section: Introductionmentioning

confidence: 99%

Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery

2016

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BackgroundThe patient’s position during spinal anesthesia administration plays a major role in the success of spinal needle insertion into the subarachnoid space. The traditional sitting position (TSP) is the standard position for spinal anesthesia administration, but the success rate for spinal anesthesia administration in the TSP is still quite low. The crossed-leg sitting position (CLSP) is one of the alternative positions for the administration of spinal anesthesia, which can increase the degree of lumbar flexion.ObjectivesThis study aimed to compare successful spinal needle placement to patients in the CLSP and patients in the TSP prior to undergoing urology surgery.MethodsThis study was a non-blinded, randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures from March-October, 2015 in the central national hospital Dr. Cipto Mangunkusumo, Indonesia. After obtaining approval from the FMUI – RSCM (Faculty of Medicine Universitas Indonesia – Rumah Sakit Dr. Cipto Mangunkusumo) Ethical Committee and informed consent from patients, 211 subjects were allocated into two groups: the CLSP group (n = 105) and the TSP group (n = 106). The proportion of successful spinal needle placement to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contacts in both groups were then assessed and analyzed.ResultsThe rate of first-time successful spinal needle insertion was not significantly different between the CLSP and TSP groups (62.9% versus 55.7%, P > 0.05). Ease of landmark palpation in the CLSP group was not significantly different from that in the TSP group (86.7% versus 76.4%, P > 0.05). The number of needle-bone contacts in both groups were not significantly different (P > 0.05). The complication rates were similar in both groups.ConclusionsThe rate of successful spinal needle placement in the CLSP group was not significantly different from that in the TSP group in patients undergoing urology surgery. The CLSP can be used as an alternative sitting position for administration of spinal anesthesia.

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Predictors of successful neuraxial block: a prospective study

Abstract: The successful location of the subarachnoid or the epidural space at the first attempt is influenced by the quality of patients' anatomical landmarks, the adequacy of patient positioning and the provider's level of experience.

Cited by 133 publications

References 12 publications

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Influence of Sedation on Patients’ Perceptions and Recovery in Patients Undergoing Minor Perianal Procedures under Spinal Saddle Block

Predicting the difficulty in performing a neuraxial blockade

Comparison of Successful Spinal Needle Placement Between Crossed-Leg Sitting Position and Traditional Sitting Position in Patients Undergoing Urology Surgery

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