Spinal Sensory Block Research Articles

Do you mind the role of spinal sensory block duration in a crucial endocrine disorder of diabetes mellitus? A prospective observational study.

Diabetes mellitus, per se, is a global health concern, which is often accompanied by complications such as diabetic neuropathy. This prospective observational study purposed to assess the durations of spinal sensory block and motor blocks in individuals with and without diabetes mellitus who had undergone spinal anesthesia. This study incorporated 80 cases, which were evenly divided into spinal sensory block without diabetes mellitus and spinal sensory block with diabetes mellitus. Various parameters were recorded at different time points, including heart rate, mean arterial blood pressure, SpO2, and spinal block characteristics. Notable measures included maximum spinal sensory block onset time, time to reach the 10th thoracic vertebra (T10), maximal spinal sensory block, time for Bromage scores, and block regression while controlling for age-related variations. Patients in the diabetic group exhibited extended block durations, with significant differences in heart rate noted at specific time points. Regarding the spinal block characteristics, the "maximum onset of SSB" and the "time to reach the T10" were more prolonged in the SSBwDM without significance. Maximum sensory spinal sensory block did not differ. However, some cases in the SSBwDM displayed blocks extending up to the T6. The times to achieve Bromage motor block scores 1-3 were shorter in SSBwDM and lost significance regarding age. Notably, the regression time was longer in SSBwDM, which held significance for both parameters. Diabetic cases commonly encounter prolonged block durations post-subarachnoid intervention, potentially linked to nerve sensitivity, age-related changes, and glycemic control. As such, attenuated local doses for diabetic neuropathic cases may enhance early mobilization, attenuate thromboembolic events, and expedite gastrointestinal recovery.

The effects of pregabalin and adductor canal block on postoperative pain in arthroscopic anterior cruciate ligament reconstruction

Background/aimTo determine the effectiveness of pregabalin and adductor canal block on opioid consumption, postoperative pain, and fast-tracking.Materials and methodsA total of 51 American Society of Anaesthesiologists (ASA) classification I–II patients aged 18–70 years who were scheduled to undergo elective anterior cruciate ligament reconstruction were included in the study. Patients were randomized into groups P, A, and C. Patients in group P (n = 16), received 150 mg of preoperative oral pregabalin, patients in group A (n = 17) received postoperative adductor canal blockade, and patients in group C (n = 18) received neither adductor canal block nor pregabalin. Surgeries were performed under spinal anaesthesia with hyperbaric bupivacaine following monitorization. Demographic data along with block features, hemodynamic data, mean opioid consumption, numerical rating scale score, White’s fast-track score, and postoperative adverse effects were recorded.ResultsFifty-seven patients were enrolled in the study, and 6 patients were excluded from the study; the data of 51 patients were included in the final analyses. Demographic characteristics and hemodynamic data were similar between the 3groups. Postoperative opioid consumption was significantly lower in groups A and P compared with group C (group P = 178.75 mg, group C = 318.61 mg, group A = 236.47 mg; P < 0.05). The regression of sensory block was significantly slower in group P (P < 0.05). The first analgesic requirement was earlier in group C than in groups P and A (P < 0.05). Patients in group P had higher fast-track scores at 8 h and 12 h compared with group C (P < 0.05); however, group A fast-track scores were similar to those of the other 2groups (P > 0.05). The rate of postoperative adverse effects was similar between the groups (P > 0.05).Conclusion Preoperative pregabalin (150 mg) reduced postoperative opioid consumption as much as adductor canal block in patients undergoing anterior cruciate ligament reconstruction. The first analgesic requirement was earlier in group C than in groups P and A. In addition, pregabalin can prolong the duration of spinal sensory block and shorten the time required to achieve high fast-tracking scores. We recommend the use of both methods as a part of multimodal analgesia.

Effects on QTc Interval of 2 Different Doses of Spinal Anesthesia in Inguinal Hernia Operations.

BackgroundCardiac arrhythmia is a significant cause of morbidity and mortality. In this study, through examination of the effects on the QTc interval of different doses of hyperbaric bupivacaine, we investigated the relationship with arrhythmia.Material/MethodsA total of 60 patients were separated into 2 groups: spinal block was applied with 10 mg bupivacaine to Group S1 and with 15 mg to Group S2. The mean arterial pressure (MAP) and heart rate (HR) values were recorded before the spinal block and at 5 and 30 min after the block and at 60 min postoperatively. By recording the time of the spinal sensory block to reach T10 dermatome (Anaesth T) and the duration of the surgical procedure (Surg T.), the QTc intervals were calculated.ResultsThe demographic data were similar in both groups. A statistically significant difference was determined between the S1 and S2 groups between the baseline and the 30 mins after spinal block QTc intervals (p=0.001). No statistically significant difference in HR values was determined between the groups at baseline, 5 min after spinal block, and 1 h after surgery (all p>0.05), but at 30 min after spinal block value there was a statistically significant difference (p=0.010). No statistically significant difference was determined in MAP values between the groups at baseline and 1 h after surgery (p>0.05).ConclusionsThe QTc interval lengthened in a dose-dependent manner after spinal anesthesia was applied with different doses of bupivacaine, but the doses used did not cause any severe arrhythmia.

English

BACKGROUND: Augmentation of the level of spinal sensory block after an epidural injection in combined spinal epidural anesthesia may be explained by a dual mechanism: a volume effect due to the compression of the thecal sac and a local anesthetic effect. AIMS: The purpose of our study was to investigate the effect of increasing the dose and volume of epidural injectate in combined spinal epidural technique. SETTINGS AND DESIGN: Prospective randomized controlled and double blind. METHODS AND MATERIAL: Fifty adult patients scheduled for lower limb surgery under combined spinal epidural anesthesia were randomly allocated to one of the five groups comprising 10 patients each. All patients received a combined spinal epidural injection using a needle through needle technique. An intrathecal injection of 10 mg (2ml) of 0.5% hyperbaric bupivacaine was given and an epidural catheter inserted in all the cases. After the maximal level of sensory blockade was attained, an epidural injection was administered according to the designated randomization code. Group I received nothing and served as the control. Groups II, III, IV & V received 20 ml of 0.25% Bupivacaine, 20ml of saline, 10ml of 0.25% Bupivacaine &10ml of saline respectively through the epidural catheter. STATISTICAL ANALYSIS: The observations were analyzed using Chi square and paired t test. RESULTS: Significant rise in the level of sensory analgesia was observed in groups II to V following the epidural injection while no change was observed in the control group. Maximum rise was observed in Group II where the dose as well as volume was maximum. CONCLUSION: We conclude that increasing the dose and volume of injectate increases the effective sensory block when utilizing the epidural volume extension technique; even after maximal sensory blockade of spinal has been achieved.

Evaluation of bupivacaine-clonidine combination for unilateral spinal anesthesia in lower limb below-knee orthopedic surgery.

Background and Objectives:The purposes of this study were to evaluate the onset, quality and duration of sensory and motor blockade between hyperbaric bupivacaine and clonidine combination with bupivacaine alone when administered intrathecally for unilateral spinal anesthesia in below-knee orthopedic surgery, efficacy of clonidine for post-operative analgesia and side-effects of clonidine, if any.Methods:Sixty ASA I and ASA II patients scheduled for elective surgery with time duration up to 90 min were studied. Patients were randomised in two equal groups by the lottery method. Group A (control group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 0.5 ml of normal saline intrathecally. Group B (clonidine group) was given Inj. bupivacaine (hyperbaric) 0.5% - 12.5 mg (2.5 ml) + 50 mcg clonidine in 0.5 ml volume intrathecally.Results:The mean peak sensory block was earlier in Group B (4.7±1.23 min) as compared with Group A (6.27±1.51 min). The mean peak motor block was earlier in Group B (6.17±1.20 min) as compared with Group A (8.63±1.71 min). The two-segment regression of sensory block was longer in Group B (106.23±9.17 min) as compared with Group A (104.43±17.75 min), which is clinically significant. Requirement of rescue analgesia was considerably prolonged in Group B (450.33±95.10 min) as compared with Group A (220±36.36 min), which was also clinically highly significant.Conclusion:Intrathecal clonidine potentiates bupivacaine induced spinal sensory block and, motor block and reduces the analgesic requirement in the early post-operative period in unilateral spinal anesthesia for lower limb below knee surgery.

Transüretral Mesane Tümörü Rezeksiyonunda Addüktör Spazmını Önlemek İçin Levobupivakain ile Obturator Blok Uygulaması

Objective: Adductor spasm can occur during transurethral resection of bladder tumour (TUR-BT) due to the stimulation of obturator nerve and can cause involuntary movement of legs, incomplete resection, bladder perforation and secondary extravesical dissemination of neoplastic cells. In this study we aimed to prevent adductor spasm and associated complications by obturator block with levobupivacain in patients with spinal anesthesia during TUR-BT for lateral wall tumors of the bladder. Material and Methods: Sixty 18-80 year-old patients, graded as ASA (American Society of Anestesiologists) I-III and scheduled for transuretral resection for lateral wall tumor of the bladder, were recruited for this study. Thirty patients, randomized as group S, received only spinal anesthesia and 30 patients randomized as group SOB, received spinal anesthesia and obturator block. Using a 22 G 50 mm insulated needle, 2 Hz, 0.5 mA electrical stimulation, with a pulse duration of 0.1 ms was applied, until the adductor muscle contractions were evoked. The local anesthetic solution 5 mL 7.5% levobupivacaine (37.5 mg) plus 5 mL 0.9% NaCl (Levobupivacaine 3.75%) was injected. Surgery was allowed after the spinal sensory block reached the T10 dermatome for all patients. Any adductor spasm occurring during surgery was recorded. Occurence of adductor muscle spasm and patient and surgeon satsifaction was evaluated. Results: Surgeon satisfaction was significantly higher in Group OBS (p<0.001) compared to Group S. Adductor spasm incidence was higher in Group S [25/30 (83%)] patients than in Group OBS [2/30 (6.7%)] patients (p<0.001). Conclusion: Obturator nerve block using levobupivacaine is effective in preventing adductor spasm in transurethral resection of lateral wall bladder tumours.

Bispectral index is related to the spread of spinal sensory block in patients with combined spinal and general anaesthesia

BackgroundA relationship between the depth of sedation as measured by the bispectral index (BIS) and spinal sensory block height in patients with light to no additional sedation has been described previously. The present study was designed to investigate the hypothesis that BIS values closely correlate with the spread of spinal sensory block in patients deeply sedated with an i.v. target-controlled infusion of propofol. MethodsSubjects comprised 100 patients aged 20–64 yr and undergoing arthroscopic knee surgery. Patients were given spinal anaesthesia with bupivacaine 0.5% (3 ml). Propofol was administered to achieve a target effect-site concentration of 3.0 μg ml−1. The relationship between the spinal sensory level at 15 min after spinal anaesthesia and BIS values during 1–5, 6–10, 11–15, and 16–20 min time intervals after the estimated effect-site concentration reached 3.0 μg ml−1 was evaluated. ResultsThe sensory level of spinal analgesia significantly and strongly correlated with BIS values during each time period after the estimated effect-site concentration remained at 3.0 μg ml−1 (P<0.0001). The correlation coefficient values were 0.8 during 1–5 min, 0.844 during 6–10 min, 0.801 during 11–15 min, and 0.804 during 16–20 min time periods. ConclusionsWe demonstrated that BIS values significantly correlate with the level of spinal sensory block under deep sedation with propofol. The depth of sedation induced by spinal anaesthesia depends on the spread of spinal sensory block.

The Effect of Injection Speed of Local Anesthetic on Success Rate of Unilateral Spinal Anesthesia

Background: The relationship between the injection speed of a local anesthetic and the success rate of unilateral spinal anesthesia has been a controversial issue. The aim of this thesis was to identify any significant effects of the drug injection speed on the success rate of unilateral spinal anesthesia. Methods: Forty patients were randomly allocated into 2 groups, group R and S. The injection speed was 4 ml/min in group R (n = 20) and 1 ml/min in group S (n = 20). Hyperbaric 0.5% bupivacaine 10 mg was injected via a syringe pump. The drug was administered at the L3-4 intervertebral space with the patient in the lateral decubitus position, which was maintained for 20 minutes after the injection. A spinal sensory block was assessed by examining the temperature sensation using an alcohol-sponge. The motor block was evaluated using the modified Bromage scale and the dependent and non-dependent sides were compared. Results: Significant differences (P ＜ 0.05) were observed in the success rate of unilateral motor paralysis (45% in group R vs 90% in group S). There were no significant blood pressure differences between the two groups 5, 10, 15, 30 and 60 minutes after injecting the hyperbaric 0.5% bupivacaine. Conclusions: The injection speed of local anesthetics is one of the crucial factors for achieving a unilateral spinal anesthesia. Therefore, it is important to maintain a slow injection speed of a local anesthetic in unilateral spinal anesthesia.

Study of Spinal Sensory Block Height with 0.5% Heavy Bupivacaine in Elderly Patients

Background: The relationship among age, height and sensory block height in elderly patients who underwent spinal anesthesia using 0.5% heavy bupivacaine were studied. Methods: Ninety-seven elderly patients, 65 years of age or older, who were scheduled for spinal anesthesia were divided into four groups. 8 mg of 0.5% heavy bupivacaine was injected in patients who were shorter than 160 cm, and 9 mg was injected in patients who were taller than 160 cm. Then they were further divided into a 65-74 year old group and an older than 75 year old group, and the area of sensory block was compared by the age and height. Results: Sensory block height was not significantly different between the 65-74 year old group and the older than 75 year old group. Height did not correlate with sensory block height in all groups and the distribution shapes showed variable patterns. Conclusions: The effect of age and height on the spinal sensory block height in elderly patients is small.

Spinal anesthesia reduces oxygen consumption in diabetic patients prior to peripheral vascular surgery

The purpose of this study was to evaluate the effect of spinal anesthesia in VO2 in a uniform high-risk patient population and also the relationship between dermatomal level of block and VO2, neither of which has been investigated previously. The effect of spinal anesthesia on VO2 was studied in 17 diabetic patients undergoing lower limb peripheral vascular surgery. Measurements were made before and 15 minutes after administration of a tetracaine spinal anesthetic. Values for VO2 and oxygen delivery (DO2) were derived from cardiac output as measured by thermodilution, hemoglobin concentration, and arterial and mixed venous blood gas analysis. The dermatomal level of the sensory block was determined by use of a hand-held nerve stimulator. Mean VO2 decreased by 27.7% (P = .001) (95% confidence limits, decrease of 22.4-90.4%). Mean DO2 and arterial blood gases were unchanged, and the mean postspinal oxygen extraction ratio (VO2/DO2) decreased by 20.5% (P = .002) (95% confidence limits, decrease of 9.1-32.3%). There was a relationship between changes in VO2 and sensory block height (P = .029). Spinal anesthesia in diabetic patients is associated with a reduction in VO2, the extent of which appears to be, at least in part, a function of the level of spinal sensory block.