The Effect of Body Mass Index on Spinal Anaesthesia for Total Knee Replacement Arthroplasty: A Dose-response Study

Kim, W. H.; Lee, J. H.; Ko, Justin Sangwook; Ahn, Hyun Joo; Park, S. K.; Gwak, Mi Sook; Kim, G. S.

doi:10.1177/0310057x1204000305

Cited by 17 publications

(12 citation statements)

References 28 publications

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“…Anesthesia failure was defined as either an induction failure or a sensory block lower than T12 at the end of the surgery. These definitions were modified from previous definitions of similar studies, focusing on the duration of spinal anesthesia and the blockade of tourniquet pain [ 13 , 14 , 20 ]. Successful anesthesia was set as the endpoint in the multivariate logistic regression analysis.…”

Section: Methodsmentioning

confidence: 99%

“…With hyperbaric bupivacaine, no significant difference in block level between obese and non-obese patients was observed in a previous study [ 3 ]. Meanwhile, recent dose-response studies compared median effective dose (ED 50 ) for successful anesthesia between obese and non-obese patients, reporting no difference [ 13 , 14 ]. However, these previous results were limited mainly to maximal block height, not block duration.…”

Section: Introductionmentioning

confidence: 99%

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Obesity Is Independently Associated with Spinal Anesthesia Outcomes: A Prospective Observational Study

et al. 2015

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The influence of body-mass index (BMI) on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA) surgery under spinal anesthesia were divided into an NO (non-obese) group (BMI < 30 kg/m2, n = 141) and an O (obese) group (BMI ≥ 30 kg/m2, n = 68). Anesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration, and if the level of sensory block was higher than T12 when the surgery ended. Logistic regression analysis with multiple variables known to influence spinal anesthesia was performed to identify which parameters independently determined the spinal anesthesia outcome. Similar doses of bupivacaine were administered to the NO and O groups. The incidence of anesthesia failure was significantly lower in the O group [n = 43 (30.5%) in the NO group vs. n = 10 (18.9%) in the O group, p = 0.014]. The independent predictors for successful anesthesia in all patients were dose of hyperbaric bupivacaine [odds ratio (OR) 2.12, 95% CI: 1.64–2.73] and obese status (BMI ≥ 30 kg/m2, OR 2.86, 95% CI: 1.25–6.52). Time to first report of postoperative pain and time to first self-void were significantly longer in the O group. These results suggest that the duration of block with hyperbaric bupivacaine is prolonged in obese patients and obesity is independently associated with spinal anesthesia outcomes, as is bupivacaine dosage. A further study enrolling patients with morbid obesity and using a fixed bupivacaine dosage is required to confirm the effect of obesity on spinal anesthesia.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Obesity Is Independently Associated with Spinal Anesthesia Outcomes: A Prospective Observational Study

et al. 2015

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“…A study has reported a direct relationship between obesity and distribution of sensory blockage [16]. It has been MRN scan that the volume of CSF in obese patients is greatly reduced [9]. However, the mechanism involved in the reduction of volume of CSF in obese patients is not properly understood.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has also been reported that there was no difference between the median effective dose (ED 50 ) of anesthesia for successful surgery between obese and non-obese patients [9]. Thus, the impact of obesity on spinal anesthesia is not yet properly understood.…”

Section: Introductionmentioning

confidence: 99%

A prospective study on the association between spinal anesthesia and obesity

Shen¹,

Liu²,

Feng³

et al. 2018

Trop. J. Pharm Res

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Purpose: To compare the outcomes of spinal anesthesia in obese and non-obese patients. Methods: In this study, 199 patients who underwent total knee replacement arthroplasty (TKRA) were categorized into obesity group (n = 61) and non-obesity group (n = 138). Anesthesia was considered successful if a bilateral T12 sensory blockage occurred within the first 15 min of injection of intrathecal drug. Parameters that influence spinal anesthesia were analyzed using logistic regression by means of multiple variables that independently influence the outcome of spinal anesthesia. Results: It was observed that the independent predictors for successful anesthesia in the patients were dose of bupivacaine (odds ratio at 95 % confidence interval = 2.08; range: 1.61-2.67) and obesity status (odds ratio at 95 % confidence interval = 2.83; range: 1.21-6.49). The outcome of the multivariate analysis also indicated that the dose of bupivacaine, body mass index (BMI) and obesity were predictors of spinal anesthesia. It was also found that the period of the sensory blockage due to bupivacaine was longer in the obesity group than in the non-obesity group. Conclusion: Sensory blockage in bupivacaine anesthesia during TKRA is influenced by dose of bupivacaine, obesity and BMI.

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“…Due to the retrospective design and analysis of only high block, this study could not answer whether the bupivacaine dose should be reduced. A prospective dose-response study compared the median effective dose (ED50) for successful anesthesia between obese (BMI ≥ 27.5 kg/m 2 ) and non-obese patients undergoing total knee arthroplasty but found no difference [2]. However, another prospective observational study found that obesity (BMI ≥ 30 kg/m 2 ) was a significant predictor of successful anesthesia by logistic regression analysis [3].…”

Section: To the Editormentioning

confidence: 99%