Tigchelaar, C. (Celien) (2017) Determining factors influencing sensory block height in spinal anaesthesia. thesis, Medicine.
Full text available on request.Abstract
Background: The spread of spinal anaesthesia is highly unpredictable. Previous studies have shown that at least 25 factors could affect the intrathecal spread of spinal anaesthesia. Most evidence suggest that baricity of the solution, dosage of local anaesthetic, patient position, level of injection and Cerebrospinal Fluid (CSF) volume are key determinants of block height. This study was designed to determine the effect of age, Body Mass Index (BMI), patient position, puncture position, anaesthetic volume, CSF glucose concentration and aspiration of CSF on the extent of sensory spinal block. Aspiration of CSF is an indirect indicator for the effect of CSF volume. Methods: The Anaesthetic Biobank of Cerebrospinal Fluid (ABC) consists of patients who received spinal anaesthesia for their surgery and 10 ml CSF was aspirated prior to administering the anaesthetic. Sensory block height was tested on both sides using ice for loss of temperature sensation. For comparison of block height, a prospective control group was formed, consisting of patients who have undergone spinal anaesthesia without CSF aspiration. A univariate correlation to test and select important predictors of the level of spinal anaesthesia was performed. The combined effect of age, BMI, patient position, puncture position, anaesthetic type, anaesthetic volume and aspiration of CSF on the spread of spinal anaesthesia was tested by multiple linear regression analysis. Results: 102 Patients in the ABC group and 106 patients in the control group were analysed. There was no significant difference between both groups regarding sensory block height. Univariate correlation showed that only BMI (r = 0.146, p = 0.035) and anaesthetic solution type (p < 0.001) were significantly correlated with the upward spread of spinal anaesthesia. CSF aspiration caused a significantly higher sensory block when isobaric bupivacaine was used as local anaesthetic in comparison with a hyperbaric anaesthetic solution (p = 0.015). Multiple regression analysis showed only type of anaesthetic solution as a significant predictor for the extent of spinal block (p < 0.006). An isobaric solution produces a higher spinal block in comparison with a hyperbaric solution. The R2 of the regression model with seven variables was 0.149. Conclusions: These findings were consistent with previous studies and indicated that baricity of the anaesthetic solution is one of the main determinants of spread of spinal anaesthesia. CSF volume is probably of more importance when using an isobaric solution than an hypo- or hyperbaric solution. Further studies could analyse more factors to help explain more of the variability of spinal anaesthetic spread.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Absalom, Prof. dr. A.R. and Co-supervisor: and Atmosoerodjo, Drs. S.D. and PhD candidate and Department of Anaesthesiology, University Medical Centre Gro |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1227 |
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