Abstract
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.Keywords: Spinal anesthesia, Total knee replacement arthroplasty, Bupivacaine, Obesity, Body mass index, Logistic regression
Highlights
Spinal anesthesia involves the injection of a local anesthesia into the subarachnoid space, using a fine needle [1]
Several reports indicate that the effect of body mass index (BMI) on spinal anesthesia is debatable in view of mixed outcomes
As a consequence of modern food habits, more and more obese patients are seen in operation theatres (OTs) these days, a situation which necessitates studying the effect of obesity on spinal anesthesia [6]
Summary
Spinal anesthesia involves the injection of a local anesthesia into the subarachnoid space, using a fine needle [1]. The position of the patient during injection, speed of injection, spinal space, specific gravity of the solution, dosage, BMI, age, gender, and height have all been investigated [4] These parameters influence the degree of blockage of sensory nerve in study subjects who undergo anesthesia during surgery [5]. It has been reported that there was no difference between the median effective dose (ED50) of anesthesia for successful surgery between obese and non-obese patients [9]. The study involved determination of independent parameters that may influence the outcome of spinal anesthesia, using multivariate analysis Parameters such as age, gender, and anesthesia dose were subjected to logistic regression analysis to identify the parameters or the factors that establish the level of the final anesthesia on completion. The predictor variables were chosen based on a backward Wald from the list of patients with a significance value of p < 0.05 and the BMI values were included in the categorical and continuous variables
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