Obesity Is Independently Associated with Spinal Anesthesia Outcomes: A Prospective Observational Study

Abstract

The influence of body-mass index (BMI) on spinal anesthesia is still controversial, with discrepant results reported in previous studies. To compare spinal anesthesia in obese and non-obese subjects, the anesthesia profiles in patients who underwent spinal anesthesia using intrathecal hyperbaric bupivacaine were compared. A total of 209 patients undergoing elective total knee replacement arthroplasty (TKRA) surgery under spinal anesthesia were divided into an NO (non-obese) group (BMI < 30 kg/m2, n = 141) and an O (obese) group (BMI ≥ 30 kg/m2, n = 68). Anesthesia was deemed successful if a bilateral T12 sensory block occurred within 15 minutes of intrathecal drug administration, and if the level of sensory block was higher than T12 when the surgery ended. Logistic regression analysis with multiple variables known to influence spinal anesthesia was performed to identify which parameters independently determined the spinal anesthesia outcome. Similar doses of bupivacaine were administered to the NO and O groups. The incidence of anesthesia failure was significantly lower in the O group [n = 43 (30.5%) in the NO group vs. n = 10 (18.9%) in the O group, p = 0.014]. The independent predictors for successful anesthesia in all patients were dose of hyperbaric bupivacaine [odds ratio (OR) 2.12, 95% CI: 1.64–2.73] and obese status (BMI ≥ 30 kg/m2, OR 2.86, 95% CI: 1.25–6.52). Time to first report of postoperative pain and time to first self-void were significantly longer in the O group. These results suggest that the duration of block with hyperbaric bupivacaine is prolonged in obese patients and obesity is independently associated with spinal anesthesia outcomes, as is bupivacaine dosage. A further study enrolling patients with morbid obesity and using a fixed bupivacaine dosage is required to confirm the effect of obesity on spinal anesthesia.

Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient

“…[4,10] The influence of obesity on EVP engorgement remains unclear. A previous study demonstrated that if the inferior vena cava is occluded by increased abdominal pressure because of the weight of the abdominal contents in obesity or increased epidural fat, blood flow through the lumbar vertebral plexus can increase and the extradural vein will distend [12] . In contrast, another study showed that the amount of epidural fat does not appear to be correlated with body mass index [13] .…”

Optimal dose of intrathecal isobaric bupivacaine in total knee arthroplasty

“…One study has described that the duration of spinal blockade in obese patients appears to be prolonged. 30 Even though our patient group contained a wide variation of BMIs, we presume this had no influence on our outcomes. Moreover, of the 11 patients in whom the dosage was insufficient and the four patients who needed general anesthesia, the mean BMI was equal to that of the sufficient group (however, these numbers are small).…”

Perioperative management of patients with concomitant morbid obesity. Guidelines of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists”

“…ň Рекомендация 18. У пациентов с ожирением рекомендуется применение регионарных и нейроаксиальных блокад [92][93][94][95][96][97] (УДД -3, УУР -А).…”