Abdominal girth and vertebral column length can adjust spinal anesthesia for lower limb surgery, a prospective, observational study

Abstract

BackgroundStudies have shown that abdominal girth and vertebral column length have high predictive value for spinal spread after administering a dose of plain bupivacaine. we designed a study to identify the specific correlations between abdominal girth, vertebral column length and a 0.5 % dosage of plain bupivacaine, which should provide a minimum upper block level (T12) and a suitable upper block level (T10) for lower limb surgeries.MethodsA suitable dose of 0.5 % plain bupivacaine was administered intrathecally between the L3 and L4 vertebrae for lower limb surgeries. If the upper cephalad spread of the patient by loss of pinprick discrimination was T12 or T10, the patient was enrolled in this study. Five patient variables and intrathecal plain bupivacaine dose were recorded. Linear regression and multiple regression analyses were performed.ResultsTotals of 111 patients and 121 patients who lost pinprick discrimination at T12 and T10, respectively, were analyzed in this study. Linear regression analysis showed that only abdominal girth and plain bupivacaine dose were strongly correlated (r =−0.827 for T12, r = −0.806 for T10; both p < 0.0001). Multiple linear regression analysis showed that both abdominal girth and vertebral column length were the key determinants of plain bupivacaine dose (both p < 0.0001). R2 was 0.874 and 0.860 for the loss of pinprick discrimination at T12 and T10, respectively.ConclusionsOur data indicated that vertebral column length and abdominal girth were strongly correlated with the dosage of intrathecal plain bupivacaine for the loss of pinprick discrimination at T12 and T10. The two regression equations were YT12 = 3.547 + 0.045X1-0.044X2 and YT10 = 3.848 + 0.047X1- 0.046X2 (Y, 0.5 % plain bupivacaine volume; X1, vertebral column length;and X 2, abdominal girth), which can accurately predict the minimum and suitable intrathecal bupivacaine dose for lower limb surgery to a great extent, separately.

Abdominal girth and dorso‐sacral distance can be used to estimate lumbosacral cerebral fluid volume

“…A high correlation between both abdominal girth and vertebral column length and lumbosacral cerebrospinal fluid volume was the primary finding of this study, which further explains the results of our previous studies . In our studies, we have demonstrated that abdominal girth and dorso‐sacral distance have a high predictive value for the spinal spread after a given dose of plain bupivacaine and can largely predict a suitable dose of plain bupivacaine for lower limb surgery.…”

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

“…Greene 4 has described 25 factors that affect the spread of spinal anaesthesia but in clinical practice it is hard to isolate one factor and quantify its effect on the spread of spinal anaesthesia from the others. There is a great interest on defining the determinants of spinal anaesthesia spread in recent studies (5)(6)(7)(8)(9). Measures that are practically obtainable and have a predictive value on spinal anaesthesia spread will help the clinicians to predict the spread of spinal anaesthesia for individual patients.…”

Sensory Block Level Prediction of Spinal Anaesthesia With 0.5% Hyperbaric Bupivacaine:&nbsp;A Retrospective Study

“…Even so, body height and weight are still more easily accessible than measurements of vertebral column length and abdominal girth. Recent studies and our results indicated that block level is negatively correlated with body height whereas it is positively correlated with body weight [6][7][8].…”

“…In addition, vertebral column length and abdominal girth have recently been reported as newly in uencing factors which should replace body height and weight for intrathecal drug spread [6][7][8]. Even so, body height and weight are still more easily accessible than measurements of vertebral column length and abdominal girth.…”

“…In our long-term daily practice, greater cephalad spread of sensory block appears to be observed in patients who are shorter, overweight, of female gender, older or who have been administered higher doses of local anaesthetic, such as hyperbaric bupivacaine (heavy Marcaine®), which we routinely use. While previous consensus support the theory that each of these factors may in uence the block level of spinal anaesthesia [4], few studies evaluated their combined effects [5][6][7][8].…”