Spread of Spinal Anaesthesia With Plain 0.5% Bupivacaine: Influence of the Vertebral Interspace Used for Injection

Abstract

Three millilitre of plain 0.5% bupivacaine was injected intrathecally at two different levels in two groups of 20 patients. Injection at the L2/3 space produced a significantly higher spread of analgesia (mean T7 (SD 3.9)) than injection at L4/5 (T11(1.8)). The range of the cephalad spread of the block was less in the L4/5 group (P less than 0.001 at 60 min). The spread of anaesthesia continued beyond 30 min in both groups. In all patients anaesthesia sufficient for surgery of the knee and the foot was achieved. One patient had a final block level of T1 after injection at L2/3, accompanied by transient arterial hypotension.

Lumbar Dural Sac Dimensions Determined by Ultrasound Helps Predict Sensory Block Extent During Combined Spinal-Epidural Analgesia for Labor

“…Furthermore, we localized the level of needle insertion using ultrasound, which is proven to be more accurate than palpation, 8 to reduce the variability produced by inaccurate identification of the insertion level. 23 Similar to Russell et al, 13 we found a large difference in levels of block assessed using cotton and either ice or pinprick. Our results showed a similar inverse correlation between the lumbar dural sac dimensions and the PSL of block to both ice and pinprick.…”

“…23 In our study, we attempted to minimize these variables by injecting a standard analgesic spinal dose of isobaric bupivacaine and fentanyl, 24 using a needle-through-needle technique to provide CSE analgesia. Furthermore, we localized the level of needle insertion using ultrasound, which is proven to be more accurate than palpation, 8 to reduce the variability produced by inaccurate identification of the insertion level.…”

Individual predictability of repeated spinal anaesthesia with plain 0.5% bupivacaine

“…The high individual predictability combined with a low variability found during the first 60 rnin after induction indicates that interindividual anatomical and physiological differences may have been responsible for the large variability found in the literature ( 1, 2,7,11,12,[14][15][16].…”

Neuraxial Blocks: Spinal and Epidural Anesthesia

“…This is further infl uenced by the curvatures of the spine [ 95 , 98 ]. (b) Level of injection : for an isobaric solution, a higher level of injection results in a greater cephalad spread of the block [ 99 ]. This is not consistently observed with hyperbaric solutions where the effect of gravity may be more profound [ 100 ].…”