Title predictors of difficult subarachnoid block

Gvalani, Sunil; Keskar, Madhavi

doi:10.18203/2320-6012.ijrms20162697

Cited by 4 publications

(8 citation statements)

References 4 publications

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“…Various patient factors are involved in making the location of correct lumbar space difficult, one such factor being abdominal circumference. We observed the association between abdominal circumference and difficulty of LP while previous studies [ 2 , 5 ] had evaluated weight and BMI. Snider et al .…”

Section: Discussionmentioning

confidence: 62%

“…Age that has been used as a difficulty predictor showed a positive correlation with the final score and was statistically significant, a finding that was similar to Gvalani SK et al . [ 5 ] and Ružman et al . [ 16 ] indicating that age increases difficulty of LP, as the prevalence of osteoporosis, degenerative and other pathological processes of spine increase with age.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, a scoring system that evaluates the probability of the difficulty encountered while performing LP is crucial. Although few studies [ 2 , 4 , 5 ] have been done to assess the variables that predict the difficulty during LP, they have shown inconsistent results. Only Gvalani et al .…”

Section: Introductionmentioning

confidence: 99%

“…Only Gvalani et al . [ 5 ] showed a significant relationship between age and difficulty encountered during LP. Some of the studies [ 2 , 4 ] had used radiological characteristics as a predictor which restricts its applicability in a broader population due to radiation exposure and cost.…”

Section: Introductionmentioning

confidence: 99%

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A comprehensive, bed-side scoring system to predict difficult lumbar puncture

Reshma

Subramanian

Iqbal

et al. 2022

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Spinal anesthesia (SA) is the most widely practiced neuraxial anesthesia. Lumbar puncture (LP) at multiple levels and multiple attempts due to any reason may cause discomfort and even serious complications. Hence the study was conducted to evaluate the patient variables that can predict difficult LP thus allowing for the use of alternate techniques. Material and Methods: We included 200 patients of ASA physical status I-II, scheduled to undergo elective infra-umbilical surgical procedures under spinal anesthesia. During preanesthetic evaluation, difficulty score was assessed using the 5 variables: Age, abdominal circumference, spinal deformity - assessed as axial trunk rotation (ATR) value, anatomical spine assessed by spinous process landmark grading system (SLGS) and patient position, by assigning a score of 0- 3 for each variable, with a total score of 0 – 15. The difficulty of LP was graded as easy, moderate or difficult based on total number of attempts and spinal levels by independent experienced investigator. The scores obtained during preanesthetic evaluation and the data collected after performing LP were analyzed using multivariate analysis and P value noted. Results: Our study showed that above patient variables correlated well with difficult LP scoring ( P < 0.001). SLGS was noted to be a strong predictor, while ATR value a weak predictor. The correlation between the total score and grades of SA had a positive association (R = 0.6832, P < 0.00001) and was statistically significant. A median difficulty score of 2, 5 and 8 predicted easy, moderate and difficult LP respectively. Conclusion: The scoring system provides for a useful tool to predict difficult LP and helps both patient and anesthesiologist to choose an alternative technique.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A comprehensive, bed-side scoring system to predict difficult lumbar puncture

Reshma

Subramanian

Iqbal

et al. 2022

Journal of Anaesthesiology Clinical Pharmacology

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“…[ 3 ] The number of attempts and levels was found to be significantly associated with abnormality of spine. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Factors predicting difficult spinal block: A single centre study

Prakash

Mullick

Kumar

et al. 2021

J Anaesthesiol Clin Pharmacol

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Background and Aims: Several factors determine the success of dural puncture. We aimed to assess the association of first puncture success and number of attempts with characteristics of the patient, provider, technique and equipment. Material and Methods: This prospective, observational study was performed in 1647 adult patients undergoing surgery under spinal anesthesia. Patient characteristics, anatomical landmarks, spinal bony deformity, provider experience, technique, skin punctures, needle redirections, subarachnoid space depth, and complications, if any, were noted. Difficult dural puncture was assessed by first puncture success and number of attempts (skin punctures plus needle redirections) required for successful needle placement. Results: First puncture success was obtained in 872 (52.9%) patients. Failed dural puncture occurred in 4 (0.2%) of 1647 patients. Multivariate logistic regression analysis revealed that longer distance from C7 vertebral spine to tip of coccyx ( P = 0.04), lower subarachnoid space depth ( P = 0.001), good quality of bony landmarks ( P = 0.001) and absence of crowded spine ( P = 0.02) were associated with first puncture success. Male gender, poor or no spinal landmarks, presence of bony deformity and lower level of provider's experience predicted increased number of attempts for successful dural puncture. Conclusion: First puncture success of spinal block was influenced only by patient's anatomical factors, whereas the number of attempts required for successful block were predicted by both provider and patient factors.

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