Spread Of Spinal Anesthesia Research Articles

Effect of Abdominal Girth and Vertebral Column Length in Spread of Spinal Anesthesia for Lower Limb Surgery: A Prospective Study

Background: Subarachnoid spread of local anesthetics is quite erratic and is determined by several factors. There is a high predictive for the spread of spinal anaesthesia in terms of abdominal girth and vertebral column length. Our study is designed to determine the effect of abdominal girth and vertebral column length with cephalad spread of spinal anaesthesia for a given dose of 0.5% hyperbaric bupivacaine in Nepalese patients. Materials and Methods: In this prospective observational study, a total 100 patients of ASA PS I-II, aged16-65 years and undergoing lower extremity surgery under spinal anesthesia were enrolled. 2.8 mL of 0.5% hyperbaric bupivacaine was injected intrathecally at L3-4 interspace in sitting position. Extent of sensory blockade was assessed for 60 min. Simple linear regression, multiple linear regression and Pearson’s correlation coefficient analysis were performed to determine the correlation between patient variables viz abdominal girth, vertebral column length, height, weight, body mass index and age and maximum sensory block height. Results: Abdominal girth and vertebral column length correlated significantly with the maximal sensory block height after intrathecal administration of a fixed dose of 0.5% hyperbaric bupivacaine by all the three statistical tools used. Conclusion: Abdominal girth and vertebral column lengthcorrelate significantly with the maximal sensory block height in Nepalese patients receiving a fixed dose subarachnoid block with 0.5% hyperbaric bupivacaine

The effect of hip shoulder width ratio and vertebral column length on sensory level in term participants posted for lower segment caesarean section under spinal anaesthesia in Indian population: A prospective observational study

Hypotension is the most common complication of spinal anesthesia with high intrathecal spread of local anaesthetic drug especially during caesarean section. Hip Shoulder width Ratio (HSWR) is one of the factors which affects spread of spinal anaesthesia.85 ASA II participants with singleton term pregnancy undergoing elective caesarean section received 12mg hyperbaric bupivacaine intrathecally with 26G Quincke’s spinal needle in L3-4 intervertebral subarachnoid space via midline approach. Post spinal anaesthesia haemodynamic parameters were monitored every 5 minutes for the first 20 minutes and at the end of surgery. Sensory level was assessed by a pinprick test every 5 minutes till 20 minutes and post-surgery. Hypotension was defined as 20% fall from baseline systolic blood pressure at 15 minutes post spinal anaesthesia.We found significant positive correlation between high shoulder width ratio and highest sensory level achieved (p - 0.0005) using mutiple regression analysis and pearson's correlataion. With every unit increased in high shoulder width ratio spinal level significantly increased by 5 units. Hip shoulder width ration and age were significantly correlatwd with incidence of hypotension.Hip-shoulder Width Ratio has a positive effect on cephalad spread of spinal anaesthesia and thus incidence of hypotension. By knowing the Hip-shoulder Width Ratio, it can help anaesthesiologists to predict the spread of spinal anaesthesia and titrate the dose of 0.5% hyperbaric bupivacaine.

Prophylactic infusion of norepinephrine does not affect the rostral spread of spinal anesthesia in pregnancy: a prospective, randomized, double-blinded study.

Background: The infusion of phenylephrine to prevent spinal-induced hypotension (SIH) in cesarean delivery may decrease the rostral spread of a spinal local anesthetic. We hypothesized that infusion of norepinephrine may decrease the rostral spread of spinal anesthesia, similar to that caused by phenylephrine. The aim of this study was to compare the block height of spinal anesthesia in the presence or absence of norepinephrine infusion administered to prevent SIH during cesarean delivery. Methods: Eighty patients were enrolled and allocated into groups receiving a norepinephrine infusion (group N) or saline infusion (group C). After intrathecal injection of hyperbaric bupivacaine 10mg, the block height for cold and pinprick sensation was checked 10 and 20min after the injection. The demographic characteristics, spinal anesthesia, side effects, and neonatal outcomes were also recorded. Results: The block height for cold and pinprick sensation was similar between the two groups, although the incidence of hypotension was significantly lower (p < 0.00) in group N than in group C. Systolic blood pressure was also more stable in group N than in group C, with the incidence of interventions being significantly lower in group N. There was no significant difference in patient satisfaction between the two groups. Conclusion: Evidence from this study suggested that prophylactic norepinephrine infusion does not reduce the rostral spread of spinal anesthesia in pregnancy. We suggest that it is not necessary to increase the dose of an intrathecal local anesthetic for cesarean delivery when prophylactic norepinephrine is administered. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=152899, identifier [ChiCTR2200057439].

Effect of Hip/Shoulder Width Ratio on the Spread of Spinal Anaesthesia in Term Parturients: A Cross-sectional Study

Introduction: There is increased cephalad spread of spinal anaesthesia with similar dose of hyperbaric bupivacaine in parturients with greater hip width and shorter shoulder width. Aim: To determine the effect of Hip and Shoulder width Ratio (HSR) on the spread of spinal anaesthesia in term parturients. Materials and Methods: The present study was a prospective cross-sectional study conducted in the Department of Anaesthesiology, Regional Institute of Medical Sciences, a tertiary care centre, at Imphal, Manipur, India, from October 2019 to September 2021. A total of 92 parturients aged 18-40 years of age, American Society of Anaesthesiologists (ASA) I and II, undergoing elective caesarean section under subarachnoid block were enrolled. With the parturient in lateral position, a 25G spinal needle was inserted in the L4-L5 interspace. A 2 mL of 0.5% hyperbaric bupivacaine was injected intrathecal in 10 seconds. Age, height, weight, Body Mass Index (BMI), HSR and Vertebral Column Length (VCL) were recorded. Spinal anaesthesia spread was assessed at 0,5,10,15,20,25,30 minutes after the procedure with pin prick test starting from the anaesthetised area and continued cephalad till the sensation changed from the dullness to sharp pain in both the mid-clavicular lines. Results: The mean age, weight, height and BMI were 28.82±6.2 years, 62.36±5.8 kilograms, 158.63±4 centimetre, and 24.77±2 Kg/m2 , respectively. HSR and shoulder width had a significant correlation with the cephalad spread of spinal anaesthesia with r=-0.672 and p-value &lt;0.001 and r=0.369 and p-value &lt;0.001, respectively. Conclusion: HSR and shoulder width has a significant correlation with spread of spinal anaesthesia with a given dose of 0.5% hyperbaric bupivacaine in parturients. The study should expect more cephalad spread of anaesthesia in parturient population when the HSR&gt;1.

Correlation between individual physical characteristics and spinal cerebrospinal fluid volume.

Spinal cerebrospinal fluid (CSF) volume is the primary determinant for the spread of spinal anesthesia. However, it cannot generally be obtained during spinal anesthesia, and patient physical characteristics are always adopted to obtain a suitable spinal spread. In this study, we sought to explore the relationship between individual physical characteristics and thoracosacral CSF volume to provide a theoretical basis for more accurate spinal anesthesia. In total 35 healthy volunteers were enrolled in this study. Three-dimensional magnetic resonance imaging was used to reconstruct and measure the spinal CSF volume. Physical characteristics and spinal CSF volume were recorded. Bivariate and multiple linear regression analyses were used to analyze the correlation between the individual physical characteristics and thoracosacral CSF volume. Total of 31 participants were included in the final analysis. Bivariate linear correlation analysis showed that the volume of thoracosacral CSF was correlated with both individual dorso-sacral distance and height (both p < 0.01), but not with abdominal girth (p > 0.05). Multiple linear regression analyses revealed that the adjusted R2 values were 0.404 for the regression equation between thoracosacral CSF volume, dorso-sacral distance, and abdominal girth. Our study showed that dorso-sacral distance and abdominal girth were essential factors contributing to thoracosacral CSF volume. A longer dorso-sacral distance and smaller abdominal girth mean larger spinal CSF volume.

Effect of abdominal girth, vertebral column length, and hip/shoulder width ratio on the spread of spinal anesthesia in term parturients undergoing elective cesarean section: A prospective observational non-randomized study

Background: Spinal anesthesia is the preferred technique for cesarean section, and a suitable level of spinal anesthesia is essential, which may be variable in every parturient. The aim of this study was to evaluate the correlation of abdominal circumference (AC), vertebral column length (VCL), hip shoulder width ratio (HSR), and vertebral column length (VCL)/Abdominal Circumference (AC)2 with the spread of spinal anesthesia in term parturient undergoing elective cesarean section. Methods: Two hundred term parturients undergoing elective cesarean section were enrolled in this prospective observational study. Spinal anesthesia was performed with 10 mg (2 ml) of 0.5% hyperbaric bupivacaine in L2-L3 or L3-L4 interspace using a 25 G Quincke needle. The cephalad spread (loss of pinprick discrimination) was assessed up to 30 minutes after intrathecal injection. Linear regression analysis was used to analyze the relationship between age, weight, height, body mass index (BMI), AC, VCL (C7-Sacral hiatus and C7-iliac crest), HSR, VCL/AC2, and the spread of spinal anesthesia. Results: The maximum sensory level showed a significant correlation with AC (P < 0.001), VCL [C7-SH and C7-IC] (P < 0.039 and P < 0.025) and VCL/AC2 (P < 0.001). Individually, hip width and shoulder width showed a significant correlation with cephalad spread of spinal anesthesia (P < 0.05); however, HSR had no significant correlation with the spread of anesthesia (P > 0.05). Conclusion: AC, VCL, and VCL/AC2 have a significant correlation with cephalad spread of spinal anesthesia when a fixed dose of hyperbaric bupivacaine is used in term parturients undergoing elective cesarean section, while HSR did not show any significant correlation.

Evaluation of Effect of Hip/Shoulder-Width Ratio on the Sensory Level of Spinal Anesthesia - A Prospective Observational Study.

Background:Certain anthropometric measurements that are practically obtainable explain the variability in the spread of spinal anesthesia. These are useful for quick assessment of the spread of spinal anesthesia to avoid the risk of high block and also the inadequate level of block.Aims:The study aims to evaluate the effect of hip/shoulder-width ratio (HSR) on the sensory level of spinal anesthesia.Settings and Design:This prospective observational study was undertaken at a tertiary care hospital.Statistical Analysis:Pearson's correlation and multiple linear regression analyses were used to analyze the relationship between study variables with the level of sensory block.Materials and Methods:One hundred patients undergoing various surgical procedures were enrolled for the study. With a patient in a sitting position, hip-width was measured between the two iliac crests, shoulder-width was measured between two acromion processes, and vertebral column length was noted by measuring the distance from C7 vertebra to sacral hiatus. 3 mL of 0.5% hyperbaric bupivacaine was administered intrathecally at L3–L4 with 25G Quincke's needle in the lateral position. Assessment of block level was done by loss of cold sensation and loss of pinprick sensation every 5 min till 30 min. The numbers of segments blocked were noted from the S5 segment. The relationship between various factors with the level of sensory block was analyzed by the Pearson's correlation coefficient.Results:HSR and body mass index (BMI) have a significant correlation with the sensory level of spinal anaesthesia, HSR (r = 0.297, P < 0.05) and BMI (r =0.385, P < 0.05).Conclusion:HSR can help predict the cephalad spread of spinal anesthesia. We can expect a higher level of sensory blockade of spinal anesthesia in females who generally have an HSR more than one.

The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study

BackgroundThe spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients.MethodsA total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores.ResultsThe rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p < 0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p < 0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p < 0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia.ConclusionsIt’s difficult to use a single factor to predict the spread of spinal anesthesia. Patient’s vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia.Trials registrationChiCTR-ROC-17012030 (Chictr.org.cn), registered on 18/07/2017.

Effect of Central Obesity on Spread of Spinal Anesthesia

Effect of Central Obesity on Spread of Spinal Anesthesia

Correlation of the lumbar dural sac dimension with the spread of spinal anesthesia in elderly female patients: A prospective observational study.

To test a hypothesis that the dural sac dimension would be correlated with the spinal block level, we evaluated the correlation between the lumbar dural sac dimension and the spread of spinal anesthesia in elderly women. In 40 women over the age of 65years, the lumbar dural sac dimensions were measured at the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces using ultrasonography in the lateral decubitus position, followed by the administration of spinal anesthesia. The correlation coefficients were analyzed for the lumbar dural sac dimension at each intervertebral level, peak sensory block level, peak motor block, time to peak sensory and peak motor blockade, durations of sensory and motor blockade, and patient characteristics. We subsequently analyzed the partial correlations between the lumbar dural sac dimension and the outcomes of spinal anesthesia, while adjusting for age, body mass index, and waist circumference. Peak sensory block level was inversely correlated with each lumbar sac dimension: L2-L3 (ρ=-0.37, P=.029), L3-L4 (ρ=-0.57, P<.001), L4-L5 (ρ=-0.65, P<.001), and L5-S1 (ρ=-0.49, P=.002) intervertebral spaces. Partial correlation analysis with adjustment for age, body mass index, and waist circumference revealed inverse correlations between the lumbar dural sac dimension at the following intervertebral spaces and peak sensory block level: L3-L4 (r=-.52, P=.003), L4-L5 (r= -.76, P<.001), and L5-S1 (r=-.65, P<.001). Outcomes of ultrasonographic investigation revealed an inverse correlation between the lumbar dural sac dimension and peak sensory block level in elderly women.

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study.

Background and Aims:Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture.Materials and Methods:All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle <50°), Group B (Cobb Angle >50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test.Results:Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B (P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45).Conclusions:The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia

The influence of Body Roundness Index on sensorial block level of spinal anaesthesia for elective caesarean section: an observational study

In this prospective trial, we investigate the effectiveness of maternal Body Roundness Index in predicting the spread of spinal anaesthesia and vasopressor requirement in parturients receiving spinal anaesthesia during the elective caesarean section. We prospectively enrolled 175 parturients. Spinal anaesthesia performed with 10 mg 0.5% hyperbaric bupivacaine at the L3–L4 intervertebral space and the optimal cut-off points of the BRI evaluated as 6.59 by receiver operating characteristic analysis calculating area under the curve. Parturients were divided into two groups with BRI <6.59 and BRI ≥6.59 for analyses. Multivariate logistic regression analysis was used to test for a relationship between variables and maximum sensory block level and vasopressor requirement. BRI was found as an independent risk factor associated with maximum sensory block level (OR = 1.378, 95% CI: 1.125–1.687, p = 0.002). Hypotension and bradycardia events after spinal anaesthesia was not associated with BRI and other variables. The present study indicates that BRI was a practical tool to predict spinal drug distribution in term parturients undergoing caesarean delivery.Impact statementWhat is already known on this subject? Spinal anaesthesia is a commonly used anaesthetic technique for the caesarean section. However, the spinal drug distribution is highly unpredictable. Anthropometric variables may predict the intrathecal drug distribution in parturients. Body Roundness Index (BRI) captures body circumference regarding height to predict body fat percentage, consider the shape of the human body as an ellipse. An ellipsoid body shape might affect the spread of spinal anaesthesia.What do the results of this study add? Our results show that the BRI was as an independent risk factor associated with maximum sensory block level in term parturients undergoing caesarean delivery.What are the implications of these findings for future clinical practice and/or further research? A future study would present the possibility to design a formula for the exact amount of local anaesthetic to be used in spinal anaesthesia with the aid of maternal BRI.

Effect of the Dural Sac Dimension on the Spread of Spinal Anesthesia

Effect of the Dural Sac Dimension on the Spread of Spinal Anesthesia

The relationship of patient characteristics to cephalad spread of spinal anaesthesia after giving 0.5% hyperbaric bupivacaine in infraumbilical surgeries

Background and Aims:Patient characteristics may explain variability of spinal anaesthesia spread to certain extent. Aim- if there is any relationship between patient characteristics – Age, gender, weight, height, body mass index, abdominal girth, vertebral column length (C7-S5) and the cephalad spread of spinal anaesthesia. Methods: In this Randomized Prospective Study, 100 patients of ASA 1 and 2 undergoing elective infraumbilical surgeries were selected. The above mentioned parameters were recorded. 3.5ml of 0.5% hyperbaric bupivacaine was injected in L3-L4 space. Cephalad spread was assessed for loss of temperature sensation and loss of pinprick discrimination at particular intervals and level was recorded. Descriptive statistics, Linear regression analysis and multiple regression analysis were used.Results: Females, height and abdominal girth in females showed significant (p= 0.000), (p= 0.01), (p= 0.01) association.Conclusion: Height, Gender (female) and abdominal girth in females were significantly correlated with the cephalad spread of anesthesia.

Relationship Between Body Mass Index and Spread of Spinal Anesthsia in Pregnant Women: A Randomized Controlled Trial.

BackgroundThe effect of body mass index (BMI) on the spread of spinal anesthesia is not completely clear. The aim of this study was to determine the dose requirements of ropivacaine and the incidence of hypotension in pregnant women with different BMIs during cesarean delivery.Material/MethodsIn this double-blind study, 405 women undergoing elective cesarean delivery were allocated to group S (BMI <25), group M (25 ≤BMI <30), or group L (BMI ≥30). Women in each group were further assigned to receive 7, 8, 9, 10, 11, 12, 13, 14, or 15 mg of spinal ropivacaine.ResultsThe ED50 and ED95 values of ropivacaine were 9.487 mg and 13.239 mg in Group S, 9.984 mg and 13.737 mg in Group M, and 9.067 mg and 12.819 mg in Group L. There were no significant differences among the 3 groups (p=0.915). Group L had a higher incidence of hypotension and a greater change in MAP after spinal anesthesia compared to the other 2 groups, and also required more doses of ephedrine than the other 2 groups when a dose of 15 mg ropivacaine was used. The incidence of hypotension had a positive correlation with the dose of ropivacaine (OR=1.453, p<0.001) and gestational age (OR=1.894, p<0.001).ConclusionsSpinal ropivacaine dose requirements were similar in the normal BMI range. However, higher doses of spinal ropivacaine were associated with an increased incidence and severity of hypotension in obese patients compared with that in non-obese patients.

Intra-abdominal pressure, vertebral column length, and spread of spinal anesthesia in parturients undergoing cesarean section: An observational study.

BackgroundIn parturients with increased physiologically intra-abdominal pressure (IAP) and a short stature, a greater cephalad spread of spinal anesthesia is often observed after a fixed amount of plain bupivacaine is administered. Therefore, we designed this prospective study to test whether IAP and vertebral column length (VCL) were predictors of spinal spread in parturients undergoing a cesarean section.MethodsA total of 113 parturients, all undergoing elective cesarean sections with single-shot spinal anesthesia, were enrolled. The L3-L4 interspace was entered, and 2 mL of 0.5% plain bupivacaine was injected into the subarachnoid space. Upon loss of temperature sensation at the T4 level, IAP was measured through a bladder catheter while the patient was in the supine position with a 10°left lateral tilt. Parturient demographic variables, including age, height, weight, IAP, and VCL were recorded. Linear regressions and multiple regressions were performed to analyze the relationships between parturient variables and the spread of spinal anesthesia.ResultsA total of 109 parturients were included in the analysis. Linear regression analysis showed a significant univariate correlation of height, weight, body mass index (BMI), IAP, and VCL with cephalad spread (all P< 0.004). Multiple linear regression analysis showed that IAP and VCL were the key determinants of spinal spread (both P < 0.0001), where as exclusion of age, weight, and height did not change the result (all P> 0.209).ConclusionsOur data indicated that IAP and VCL were significant predictors of intrathecal spread of plain bupivacaine, and there was a positive association between IAP and abdominal girth in term parturients.

Hip/Shoulder Width Ratio Alters the Spread of Spinal Anesthesia: A Prospective Observational Study

Introduction: Many factors have been tested to predict the spread of spinal anesthesia in clinical practice. In the study, we aimed to investigate the correlation between hip/shoulder width ratio and spread of spinal anesthesia. Method: Sixty patients were enrolled in this study to determine the correlation between hip/shoulder width ratio and the spread of spinal anesthesia. The L4-L5 interspace, navigated by ultrasonography, was introduced at the lateral position with a 25G spinal needle. 3ml 0,5% hyperbaric bupivacaine was injected intrathecally in 15 seconds. Age, height, weight, body mass index, hip/shoulder width ratio, and vertebral column length were recorded. Spinal anesthesia spread was assessed at 0, 5, 10, 20, and 30 minutes after spinal anesthesia. The patient was turned supine 5 minutes after intrathecal injection. Multiple linear regression analysis was used to analyze the correlation between the spread of spinal anesthesia and age, height, weight, hip/shoulder width ratio, vertebral column length. Results: The study was completed without dropout and sixty participants were included in the analysis. There was a strong correlation between the spread of spinal anesthesia and hip/shoulder width ratio (r=0,766; p

Body height and the spread of spinal anaesthesia for caesarean section: a prospective controlled trial.

No conclusive evidence exists on the effect of patient height on the spread of spinal anaesthesia. Our aim was to measure the ED50 and ED95 values of intrathecal ropivacaine in taller and shorter patients, and thus investigate the hypothesis that the spinal dose requirement in shorter patients is lower than that in taller patients undergoing caesarean section. In this study, 270 pregnant women were assigned to the taller (Group T) or shorter group (Group S) based on their heights. Subjects in both groups were further randomly assigned to one of nine subgroups based on the dosage of intrathecal isobaric ropivacaine to be administered (7, 8, 9, 10, 11, 12, 13, 14 or 15 mg respectively). The ED50 and ED95 values of ropivacaine were 9.24 mg and 13.36 mg in Group S, and 10.11 mg and 14.63 mg in Group T, with no inter-group difference (P = 0.886). There was a significant inter-group difference in the incidence of hypotension and the changes in mean arterial pressure after spinal anaesthesia using 15 mg ropivacaine. The dose of ephedrine administered in Group S was higher than that in Group T when 15 mg ropivacaine was administered (P = 0.031). The taller and shorter patients did not respond differently to modest intrathecal doses of ropivacaine. However, a larger dose of ropivacaine was associated with an increased incidence of hypotension in shorter patients compared to that in taller patients.

Relationship Between Central Obesity and Spread of Spinal Anesthesia in Female Patients.

Central obesity may be related to the spread of spinal anesthesia in female patients. Fifty-seven female patients undergoing spinal anesthesia were allocated to either the central obesity or noncentral obesity group. After induction of spinal anesthesia, maximal sensory blockade (primary outcome), time for maximal sensory block, maximum motor block, time to maximum motor block, time to L2 regression, and time to Bromage scale 0 were evaluated. Multiple linear regression analyses showed that maximal sensory blockade was related to central obesity (P = .004). Central obesity is related to a more extensive spread of spinal anesthesia in female patients.

The Impact of Gestational Age and Fetal Weight on the Risk of Failure of Spinal Anesthesia for Cesarean Delivery

(IJOA. 2016;26:8–14) The spread of spinal anesthesia may be increased during pregnancy, and hence pregnant women are considered to need a smaller dose of local anesthetic than nonpregnant women to achieve the same spinal block level. Data on spinal dosing for preterm (&lt;37 wk of gestation) versus term (≥37 wk of gestation) parturients is limited. One earlier study found that standard doses of hyperbaric bupivacaine used for cesarean delivery failed to provide as high of a spinal block in women with preterm gestations compared to women at term. The aim of this study was to investigate the hypothesis that preterm gestation was associated with an increased risk of failed spinal anesthesia for cesarean delivery when compared with term gestation.