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Spinal Block (spinal + block)

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Medical Sciences	100%

Selected Abstracts

Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009
G. FANELLI
Purpose: The aim of this prospective, randomised, blind study was to compare the evolution of spinal block produced with 50 mg lidocaine 10 mg/ml and 10 mg ropivacaine 5 mg/ml for outpatient knee arthroscopy. Methods: Thirty outpatients undergoing knee arthroscopy received 50 mg of lidocaine 10 mg/ml (n=15) or 10 mg of ropivacaine 5 mg/ml (n=15) intrathecally. The evolution of spinal block was recorded until home discharge, while the occurrence of transient neurologic symptoms (TNS) was evaluated through phone-call follow-ups. Results: The median onset time was 15 (10,21) min with lidocaine and 24 (11,37) min with ropivacaine (P=0.109). Spinal lidocaine resulted in a faster resolution of sensory block [148 (130,167) min vs. 188 (146,231) (P=0.022)], unassisted ambulation with crutches [176 (144,208) min vs. 240 (179,302) min (P=0.014)], and voiding [208 (163,254) min vs. 293 (242,343) min (P=0.001)] than ropivacaine. Recovery of motor function required 113 (95,131) min with lidocaine and 135 (87,183) with ropivacaine (P=0.219). Six lidocaine patients reported TNS (40%) as compared with no patient receiving ropivacaine (0%) (P=0.005). Conclusions: Spinal block produced with 10 mg ropivacaine 5 mg/ml is as effective as that produced by 50 mg of lidocaine 10 mg/ml. Recovery of unassisted ambulation and spontaneous voiding occurred earlier with lidocaine, but this was associated with a markedly higher incidence of TNS. [source]

Spread of spinal block in patients with rheumatoid arthritis

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010
K. A. LEINO
Background: In clinical practice, we noticed a greater than expected spread of sensory spinal block in patients with rheumatoid arthritis. We decided to test this impression and compared the spread of standard spinal anaesthesia in rheumatoid and non-rheumatoid control patients. Methods: Spinal anaesthesia with 3.4 ml (17 mg) of plain bupivacaine was administered to 50 patients with seropositive rheumatioid arthritis and to 50 non-rheumatoid control patients. The protocol was standardised for all patients. All the patients were undergoing lower limb surgery and the rheumatoid patients were operated on due to their rheumatoid disease. The spread of sensory block was recorded 30 min from the dural puncture using a pin prick test and a cold ice-filled container. The impact of body mass index (BMI), height and age on the spread were analysed. Results: The spread of sensory block was greater in patients with rheumatoid arthritis (15.6±3.1 dermatomes) than in non-rheumatoid patients (14.1±3.3 dermatomes) (P<0.05). Increasing BMI was related to cephalad spread of block in the rheumatoid group (P<0.05), but not in the control group. Conclusion: The mean spread of sensory block 30 min after the injection of plain bupivacaine was 1.5 segments cephalad in patients with rheumatoid arthritis than in those without this disease. BMI might be a patient-related factor contributing to the extent of the block in rheumatoid patients. These findings should be considered when performing a spinal block in rheumatoid patients. [source]

Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009
M. J. YUN
Background: In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. Methods: The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 ,g/kg, followed by a continuous infusion of alfentanil 0.25 ,g/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. Results: VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1,4) vs. 3.5 (2,6), P=0.001], and the mean (± SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 ± 2.7 min vs. 10.8 ± 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). Conclusions: An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures. [source]

Intrathecal ropivacaine 5 mg/ml for outpatient knee arthroscopy: a comparison with lidocaine 10 mg/ml

Spinal 2-chloroprocaine: effective dose for ambulatory surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2008
A. SELL
Background: There is an interest in finding a safe, short-acting spinal anaesthetic, suitable for ambulatory surgery. In this prospective study, we evaluated the effective dose of plain 2-chloroprocaine (2-CP) for lower limb surgery, including knee arthroscopy and saphenectomy. Methods: Sixty-four ASA physical status I,III patients undergoing elective lower limb surgery were randomly allocated to one of the four local anaesthetic groups for spinal anaesthesia in a double-blind manner. The patients (n=16 patients in each group) received 35, 40, 45 or 50 mg of 10 mg/ml isobaric 2-CP. Results: In all patients, anaesthesia was sufficient for the planned surgery. The median peak block height (T9) was similar in all four groups (P=0.66). Time to complete sensory block regression was faster in the 35 mg group (111 min, mean) and in the 40 mg group (108 min) than in the 50 mg group (134 min, P=0.005). No differences in time to complete motor block regression were observed (P=0.3). Home discharge time was faster in the 35 mg group (123 min) and in the 40 mg group (122 min) than in the 50 mg group (165 min, P=0.001). No complications related to spinal anaesthesia were observed and no transient neurologic symptoms (TNS) were reported at the 3-day follow-up. Conclusion: Spinal 2-CP, 10 mg/ml 35, 40, 45 and 50 mg provide reliable sensory and motor block for ambulatory surgery, while reducing the dose of 2-CP to 35 and 40 mg resulted in a spinal block of faster ambulation. [source]

Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both?

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2003
A. Kararmaz
Background:, To enhance the spread of spinal anaesthesia, fentanyl may be administered intrathecally (i.t.) or intravenously (i.v.). The purpose of this prospective study was to investigate the effects of fentanyl administered i.v., i.t. or concurrently by both i.v. and spinal routes on the spread of spinal anaesthesia. Methods:, Sixty patients were randomly assigned to one of three groups. In Groups I and II, spinal anaesthesia was performed with plain bupivacaine 10 mg plus 20 µg fentanyl and in Group III with 10 mg of plain bupivacaine. The level of first peak sensory block was marked. In addition, fentanyl 50 µg was administered i.v. in Groups II and III or by saline in Group I after the sensory blockade reached the highest dermatomal level. Ten minutes after i.v. administration, the level of the second peak sensory block was marked. The distance between the first- and second-highest levels of sensory block was measured. Results:, The distance between the first- and second-highest level of sensory block was significantly different for the three groups: Group II (5.8 ± 2.6 cm) > Group III (2.9 ± 2.1 cm) > Group I (,0.15 ± 1.7 cm). The peak dermatomal level of spinal block was significantly higher in Group II [T4 (T3,T7)] than in Group I [T6 (T4,T9)] and Group III [T6 (T4-T8)]. In Groups I and II the sensory block regressed to S2 for a longer period of time than it did in Group III. Conclusion:, Both the spinal and systemic administration of fentanyl enhanced the spread of spinal anaesthesia. The co-administration of spinal and i.v. fentanyl produced a greater increase in the cephalad spread of spinal block. [source]

Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series

ANAESTHESIA, Issue 7 2010
S. M. Kinsella
Summary General anaesthesia is the fastest method for anaesthetising a category-1 caesarean section but is associated with increased maternal morbidity and mortality. We describe the ,rapid sequence spinal' to minimise anaesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anaesthesia if there are delays or problems. We present a case series of 25 rapid sequence spinal anaesthetics for category-1 caesarean section. The mean (SD [range]) decision-delivery interval was 23 (6 [14,41]) min. After excluding cases where there was an identified delay, the median (IQR [range]) time to prepare and perform the spinal was 2 (2,3 [1,7]) min, and time to develop a ,satisfactory' block was 4 (3,5 [2,7]) min. The total time to induce spinal anaesthesia was 8 (7,8 [6,8]) min. There were three pre-operative conversions to general anaesthesia and three women had pain during surgery that did not require treatment. Our data indicate that one might expect to establish anaesthesia in 6,8 min using a rapid sequence spinal. Careful case selection is crucial. While rapid anaesthesia is important, the reduction of the decision-delivery interval also requires attention to other stages in the pre-operative process. [source]

The tenth rib line as a new landmark of the lumbar vertebral level during spinal block

ANAESTHESIA, Issue 4 2004
C.-W. Jung
Summary The purpose of this study was to assess whether the tenth rib line (an imaginary line that joins the lowest points of the rib cage on the flanks) could be used as a marker of the lumbar vertebral level. Simple X-rays (n = 100) were taken with radiopaque markers attached on the lowest points of the rib cage and the uppermost points of the iliac crests on both flanks. The spinous process or interspinous space that the tenth rib or Tuffier's lines crossed was identified and recorded, respectively, in the neutral and fully flexed positions. With lumbar flexion, the tenth rib line (median (25th to 75th percentiles)) moved upward (L2 (L1,2 , L2) vs. L1,2 (L1,2 , L1,2); p < 0.01), but Tuffier's line moved downward (L4,5 (L4 , L4,5) vs. L4,5 (L4 , L5); p < 0.01). Because the ease of palpating the tenth rib line and its distribution patterns are comparable to those of the Tuffier's line, the tenth rib line may be useful as a new landmark of the lumbar vertebral level as well as a safeguard to prevent spinal puncture from being mistakenly performed at a dangerously high level. [source]