Differential Spread of Blockade of Touch, Cold, and Pinprick during Spinal Anesthesia

Rocco, Angelo G.; Raymond, Scott B.; Murray, Ellen; Dhingra, Usha; Freiberger, Dubravka

doi:10.1213/00000539-198509000-00011

Cited by 69 publications

(40 citation statements)

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“…We have found a significant correlation of block heights between modalities suggesting that all provide potentially useful information about block height albeit at different levels. We found a wide variation in the assessments of block height between modalities and as previously reported [9]; these were lower for touch than for cold or pinprick, which in turn were lower than that measured as icy without change from the reference point (Table 1). More than three quarters of the women in our study failed to have a block to touch that reached T6 at the time anaesthesia was thought to be adequate to commence surgery, and of these, only five (5%) required an additional pharmacological intervention ( Table 2).…”

Section: Discussionsupporting

confidence: 81%

“…However, the reliance on touch alone could lead to unnecessarily increasing the dose of local anaesthetic injected during spinal anaesthesia, delaying the start of caesarean section, or even abandoning perfectly adequate anaesthesia [7]. Modalities available to assess block height include the Neurotip TM (Owen Mumford, Oxford, UK), ethyl chloride spray and light pressure with a finger to assess touch; an 18-G needle to assess pinprick; and ethyl chloride spray, alcohol swab and ice to assess temperature [5,[8][9][10]. There are problems with some of these methods of assessment.…”

mentioning

confidence: 99%

“…Although various modalities have been tested in a controlled way at various time intervals after injection of intrathecal injectate [3,9], there appears a paucity of literature reporting the assessment of block height at the time point when the anaesthetist considers that it is satisfactory for the obstetrician to proceed with caesarean section. We therefore aimed to investigate the block height levels recorded by anaesthetists in our institution when spinal anaesthesia was assessed as clinically satisfactory for caesarean section to proceed.…”

mentioning

confidence: 99%

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Assessment of block height for satisfactory spinal anaesthesia for caesarean section

et al. 2012

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

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confidence: 99%

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Assessment of block height for satisfactory spinal anaesthesia for caesarean section

et al. 2012

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“…In spinal anaesthesia, the loss of sensation to touch is slower in onset and regresses more rapidly than the loss of sensation to pinprick, this may be due to differential block of different nerve fiber types and that differential block is greater during regression of anesthesia which occurs at the end of the surgery [14].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

Omar¹,

Elhamid²,

Rady³

et al. 2017

OJAnes

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Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoralsciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was 89directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.

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“…Diferansiyel duyusal sinir bloğu A-ß, A-δ ve C lifl erinin farklı derecelerde bloke olmasıyla ortaya çıkar 5,6 . Spinal anestezi sonrasında duyusal blok seviyesinin belirlenmesinde pinprick ve soğuk uygulama sık kullanılan yöntemlerdir ve bunlardan pinprick uygulaması A-δ ve soğuk uygulaması C lifl erinin etkilendiğini gösterir.…”

Section: Bulgularunclassified

Assessment of block level with cold or pin-pirick stimulation during bupivacaine induced spinal anesthesia

Yektaş¹

2013

Kafkas J Med Sci

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GirișSpinal ve epidural anestezi sonrasında duyusal blok seviyesinin belirlenmesi için geleneksel pinprick testi, dokunma ve soğuk uygulaması kullanılabilir 1,2 . Pinprick testi duyarlı bir test olmasına rağmen, enfeksiyon ve ağrıya neden olabilir. Hastalar testin neden olduğu ağrılı durumdan hoşnut olmayabilirler ve testin konforlu olmadığından şikayetçi olabilirler. Spinal anestezide blok düzeyini değerlendirmek için cilt vazomotor refl eksi, basınç uygulanması, iğneleyici ağrı silindiri ve jet gaz metodu gibi bazı yöntemler tanımlanmıştır 3,4 . Ancak bunlar kullanım zorluğu nedeniyle yaygınlaşmamış ve soğuk uyaranına üstünlükleri gösterilememiştir.Bu çalışmada spinal anestezi sırasında blok seviyesini belirlemek için kullanılan geleneksel yöntem olan pinprick uyaranıyla, soğuk uyaranını karşılaştırmayı amaçladık. YÖNTEM:

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Differential Spread of Blockade of Touch, Cold, and Pinprick during Spinal Anesthesia

Cited by 69 publications

References 0 publications

Assessment of block height for satisfactory spinal anaesthesia for caesarean section

Assessment of block height for satisfactory spinal anaesthesia for caesarean section

The Effect of Different Regional Blocks: Combined Femoral-Sciatic, Spinal and Epidural Blocks on the Different Side Effects of Arterial Tourniquet in Patients Undergoing Lower Limb Orthopedic Surgeries —A Randomized Controlled Trail

Assessment of block level with cold or pin-pirick stimulation during bupivacaine induced spinal anesthesia

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