Abdominal girth, vertebral column length and spread of intrathecal hyperbaric bupivacaine in the term parturient

Wei, Changna; Zhang, Yinfa; Feng, Xia; Wang, Lizhong; Zhou, Qinghe

doi:10.1016/j.ijoa.2017.02.002

Cited by 28 publications

(36 citation statements)

References 20 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Cantürk¹,

Hakki²,

Kocaoğlu³

2018

Ulutas Med J

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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 lateral position with a 25G spinal needle. 3ml 0,5% hyperbaric bupivacaine was injected intrathecal 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. Patient was turned supine 5 minutes after intrathecal injection. Multiple linear regression analysis was used to analyze 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 into analysis. There was a strong correlation between the spread of spinal anesthesia and hip/shoulder width ratio (r=0,766; p<0,0001) and a negative correlation with the height and vertebral column length (r= -0,572; -0,738 and p=0, 000; 0, 000 respectively).Conclusion: Cephalad spread of spinal anesthesia with a fixed dose of hyperbaric bupivacaine is strongly correlated with hip/shoulder width ratio and inversely correlated with height and vertebral column length. We may observe more spread with 0, 5% hyperbaric bupivacaine in patients with a greater hip/shoulder ratio and a shorter height.

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Section: Introductionmentioning

confidence: 99%

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

Cantürk¹,

Hakki²,

Kocaoğlu³

2018

Ulutas Med J

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“…Chun et al (10) also found that IAP did not correlate with SAD. Although most of the studies have assessed abdominal obesity by measuring the abdominal girth in parturients (6,(12)(13)(14), Katulanda et al (15) suggested that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity. Therefore, we decided to include the SPX as well as the SPF in our study.…”

Section: Discussionmentioning

confidence: 99%

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Günüşen¹,

Sargın²,

Akdemir³

et al. 2019

Turk J Med Sci

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Introduction Spinal anesthesia is a safe, simple, rapid, effective, and easy-to-apply anesthetic technique for cesarean sections. Despite the advantages of spinal anesthesia, hypotension is a common complication with an incidence of 70%-85% in parturients (1-4). Many factors including the characteristics of the injected solution, patient position, age, height, weight, pregnancy, intraabdominal pressure (IAP), length of the vertebral column, and lumbosacral cerebrospinal fluid (CSF) volume determine the intrathecal spread of local anesthetics. In obstetric patients, physiological changes due to pregnancy, including changes in spinal curvature, venous pooling secondary to progesterone-induced decreases in vascular tone and aortocaval compression by the gravid uterus, contribute to hypotension during cesarean section under regional anesthesia (1-6). Many recent studies have addressed the effects of uterine size, abdominal girth, and IAP on sensory block level, ephedrine dose, and the incidence of hypotension in pregnant women. Large abdominal girth, big uterus, and increased IAP may be significant factors in greater cephalad spread of local anesthetics. The mechanisms explained in these studies are that the increased IAP secondary to the compression of the inferior vena cava due to the growing uterus leads to a reduction in CSF in the spinal canal (1,7-14). We hypothesized that there may be differences in the sensory block level and ephedrine requirements among pregnant women based on uterine size and the presence of abdominal obesity. The primary purpose of this study was to determine whether there is a relationship between uterine size and sensory block level and ephedrine dose in parturients receiving spinal anesthesia. Since Katulanda et al. (15) reported that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity, we considered SPX to be a marker of both abdominal obesity and uterine size that contains abdominal obesity, easily identified anatomical landmarks Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block leve...

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“…Our previous study demonstrated that abdominal girth and vertebral column length have high predictive values for the spinal spread in the term parturient. [ 20 ] However, the results did not provide a specific intrathecal hyperbaric bupivacaine dose for an individual parturient. A previous study suggested that T5 blockade to pinprick might be a suitable marker for determining intrathecal hyperbaric bupivacaine efficacy before cesarean section.…”

Section: Introductionmentioning

confidence: 97%

Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section

Wei¹,

Zhou

Wang³

2017

Medicine

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Currently, there is no consensus on how to determine the optimal dose of intrathecal bupivacaine for an individual undergoing an elective cesarean section. In this study, we developed a regression equation between intrathecal 0.5% hyperbaric bupivacaine volume and abdominal girth and vertebral column length, to determine a suitable block level (T5) for elective cesarean section patients.In phase I, we analyzed 374 parturients undergoing an elective cesarean section that received a suitable dose of intrathecal 0.5% hyperbaric bupivacaine after a combined spinal-epidural (CSE) was performed at the L3/4 interspace. Parturients with T5 blockade to pinprick were selected for establishing the regression equation between 0.5% hyperbaric bupivacaine volume and vertebral column length and abdominal girth. Six parturient and neonatal variables, intrathecal 0.5% hyperbaric bupivacaine volume, and spinal anesthesia spread were recorded. Bivariate line correlation analyses, multiple line regression analyses, and 2-tailed t tests or chi-square test were performed, as appropriate. In phase II, another 200 parturients with CSE for elective cesarean section were enrolled to verify the accuracy of the regression equation.In phase I, a total of 143 parturients were selected to establish the following regression equation: YT5 = 0.074X1 − 0.022X2 − 0.017 (YT5 = 0.5% hyperbaric bupivacaine volume for T5 block level; X1 = vertebral column length; and X2 = abdominal girth). In phase II, a total of 189 participants were enrolled in the study to verify the accuracy of the regression equation, and 155 parturients with T5 blockade were deemed eligible, which accounted for 82.01% of all participants.This study evaluated parturients with T5 blockade to pinprick after a CSE for elective cesarean section to establish a regression equation between parturient vertebral column length and abdominal girth and 0.5% hyperbaric intrathecal bupivacaine volume. This equation can accurately predict the suitable intrathecal hyperbaric bupivacaine dose for elective cesarean section.

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Abdominal girth, vertebral column length and spread of intrathecal hyperbaric bupivacaine in the term parturient

Cited by 28 publications

References 20 publications

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

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

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section

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