Abstract
Background: Anesthesiologists are reluctant to considerer higher levels for spinal anesthesia largely due to direct threats to spinal cord. Paresthesias are relatively common during spinal needle insertion; however, the clinical significance of the paresthesia is unknown. The main objective of this prospective study was to evaluate the incidence of paresthesia and neurologic complications after lower thoracic spinal anesthesia with a cut needle compared to a pencil point needle. Methods: Low thoracic spinal puncture (T10-T11) was performed in 300 patients in elective surgery using different techniques in this single-blind prospective trial. Patients randomized to 2 groups: group 1, subarachnoid puncture using a cut needle without introducer and group 2, subarachnoid puncture using a pencil point needle with introducer. In both groups patients were in the lateral or sitting position. Results: Paresthesias occurred in 20/300 (6.6%) of patients. Seven patients experienced a paresthesia with cut needle compared with 13 patients with pencil point, without statistical difference. All paresthesias were transient. No neurologic complications were observed in all patients during this study. Conclusions: Our data suggest that all transient paresthesia are transitory. Lower thoracic puncture is safe. Traumatic injury to the spinal cord is a rare cause of neurologic deficits in the thoracic puncture.
Highlights
Spinal anesthesia is commonly used in many surgical procedures
The anatomy of the thoracic spinal canal was investigated with MRI in 19 [3] and 50 [4] patients, and it has been demonstrated the safety of the segmental spinal anesthesia at T10 by using the combined spinal-epidural technique [5] or single puncture [6]
The first end-point of this prospective study was to evaluate the incidence of paresthesia and neurologic complications after lower thoracic spinal anesthesia with a cut needle compared to a pencil point needle
Summary
Spinal anesthesia is commonly used in many surgical procedures. High spinal anesthesia has been employed for operations on the skull, on the throat and on the thorax [1]. Segmental spinal anesthesia of the lower thoracic and upper lumbar dermatomes was produced in ten adult human subjects by the intrathecal deposition of 0.5 ml. Only 2% performed procedure thoracic spinal anesthesia [7]. Anesthesiologists are reluctant to considerer higher levels for spinal anesthesia largely due to direct threats to spinal cord. The main objective of this prospective study was to evaluate the incidence of paresthesia and neurologic complications after lower thoracic spinal anesthesia with a cut needle compared to a pencil point needle
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