Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study

Background: When performing spinal anesthesia for cesarean section, it is important to determine the appropriate anesthetic dose as well as to predict the level of spinal anesthesia. In this study, it was hypothesized that some anthropometric measurements may be related to maximum sensory block and hemodynamic changes. Objectives: The aim of this study are to find maternal anthropometric values that are correlate with the level of spinal anesthesia. Methods: Maternal anthropometric measurements, including height, weight, supine and standing abdominal circumference (AC), and hip circumference, were recorded before spinal anesthesia for cesarean section. Spinal anesthesia was induced by administering 8 mg of 0.5% hyperbaric bupivacaine and 20 μg of fentanyl at the L3-L4 interspace. The level of sensory block was determined using pin-prick at 1, 5, 10, and 15 minutes after spinal anesthesia. The sensory block level and hemodynamic adverse events were analyzed in relationship to anthropometric measurements. Results: The supine AC/height ratios significantly correlate with the maximal sensory block level at 5, 10, and 15 minutes after the injection of spinal anesthetic (p = 0.001, p < 0.001 and p < 0.001, respectively). Further, there were significant correlations between body mass index (BMI) and sensory block level at every assessment (p = 0.041, p = 0.002, p = 0.001 and p < 0.001, respectively). When comparing the groups with and without hypotension, BMI, weight, and supine AC/height ratio were found to be significantly higher in the group with hypotension (p = 0.002, p = 0.004 and p = 0.006, respectively). Conclusions: We conclude that BMI and AC/height ratio correlate with the sensory block level of spinal anesthesia for cesarean section.

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Influence of Positioning on Plain Levobupivacaine Spinal Anesthesia in Cesarean Section

Anesthesiology Research and Practice ◽

10.1155/2010/212696 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Fabio Gori ◽

Francesco Corradetti ◽

Vittorio Cerotto ◽

Vito Aldo Peduto

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Supine Position ◽

Motor Block ◽

Sensory Block ◽

Sensory Level ◽

Physical Status ◽

Gravitational Forces ◽

Block Level ◽

Dermatomal Level

Background. The behaviour of isobaric levobupivacaine in relation to gravity when used in obstetric spinal anesthesia is unclear.Methods. 46 women with ASA physical status 1 undergoing cesarean section were randomly allocated to 2 groups. Spinal anesthesia with 12.5 mg levobupivacaine was performed in the sitting position in all women. Those in the first group were placed in the supine position immediately after the injection, while those in the second group were asked to remain seated for 2 minutes before assuming the supine position. The sensory block level, the onset of sensory and motor blocks, the regression of the sensory block for 2 dermatomes of the sensory block, the first request for analgesics, and the regression of motor block were recorded.Results. No differences in onset times, sensory level, or Bromage score were observed between the two groups. The time of first analgesic request was earlier in the seated group (supine131±42 min, seated106±29 min,P=.02).Conclusion. Isobaric levobupivacaine in women at term produces a subarachnoid block the dermatomal level of which does not depend on gravitational forces.

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The Effect of Intra-Abdominal Pressure on Sensory Block Level of Single-Shot Spinal Anesthesia for Cesarean Section

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000479531.51437.6c ◽

2016 ◽

Vol 36 (1) ◽

pp. 50-51

Author(s):

T. Ozkan Seyhan ◽

M. Orhan-Sungur ◽

B. Basaran ◽

M. Savran Karadeniz ◽

F. Demircan ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Sensory Block ◽

Abdominal Pressure ◽

Single Shot ◽

Block Level

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Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060518797000 ◽

2019 ◽

Vol 47 (7) ◽

pp. 2785-2799 ◽

Cited By ~ 3

Author(s):

Xin Liu ◽

Xiongjie Zhang ◽

Xujian Wang ◽

Jinyan Wang ◽

Hao Wang

Keyword(s):

Confidence Interval ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Outcome Measure ◽

Meta Analysis ◽

Sensory Block ◽

Cochrane Library ◽

Secondary Outcome ◽

Control Group ◽

Block Level

Objective This meta-analysis was performed to evaluate the effect of spinal anesthesia (SA) using bupivacaine combined with dexmedetomidine (DEX) in cesarean section, analyze the adverse drug reactions induced by this mixture, and provide a reference for rational drug use. Methods Randomized controlled trials were obtained from the PubMed, Cochrane Library, and Embase databases. The primary outcome measure was the time to the highest sensory block level (min), and the secondary outcome measure was adverse effects. Results The time to the highest sensory block level was significantly shorter in the bupivacaine-DEX group than in the control group (standardized mean difference, −0.23; 95% confidence interval, −0.43 to −0.03). The incidence of shivering during the process of anesthesia, especially at a dose of 5 µg DEX, was significantly lower in the bupivacaine-DEX group than in the control group (odds ratio, 0.26; 95% confidence interval, 0.14–0.49). No significant differences were observed in the symptoms of hypotension, bradycardia, nausea/vomiting, or pruritus. Conclusion Compared with the use of bupivacaine alone for SA in cesarean section, adding dexmedetomidine during SA can significantly shorten the onset time and decrease the rate of shivering during anesthesia.

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Changes of Serum Glucose according to Sensory Block Level and Intrathecal Epinephrine , Morphine during Spinal Anesthesia

Korean Journal of Anesthesiology ◽

10.4097/kjae.1992.25.6.1137 ◽

1992 ◽

Vol 25 (6) ◽

pp. 1137

Author(s):

Ho Jung Lee ◽

Man Mo Yoon ◽

Bong Il Kim

Keyword(s):

Spinal Anesthesia ◽

Sensory Block ◽

Serum Glucose ◽

Block Level

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Risk Factors for Shivering During Cesarean Section Under Spinal Anesthesia: A Prospective Observational Study

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000719636.25967.06 ◽

2020 ◽

Vol 40 (4) ◽

pp. 214-214

Author(s):

B. Wódarski ◽

R. Chutkowski ◽

J. Banasiewicz ◽

K. Moorthi ◽

S. Wójtowicz ◽

...

Keyword(s):

Risk Factors ◽

Observational Study ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Prospective Observational Study

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Comparison of effects of Bupivacaine and Ropivacaine in patients undergoing elective Caesarean section

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i3.27042 ◽

2020 ◽

Vol 4 (3) ◽

pp. 859-863

Author(s):

Sangeeta Subba ◽

Arjun Arjun Chhetri ◽

Rupak Bhattarai

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Motor Block ◽

Elective Caesarean Section ◽

Sensory Block ◽

Elective Cesarean Section ◽

Hyperbaric Bupivacaine ◽

Safe Alternative ◽

Elective Cesarean ◽

Group B

Introduction: Spinal anesthesia is considered a reasonable choice for cesarean section. Bupivacaine and ropivacaine have been used as intrathecal drugs alone or in combination with various opioids. Ropivacaine is considered a valid and safe alternative to bupivacaine for spinal anesthesia. Objectives: To compare the efficacy and safety of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Methodology: Sixty pregnant women undergoing elective cesarean section were allocated into two groups. Group R received 3 ml of 0.5% hyperbaric ropivacaine (2 ml 0.75% plain ropivacaine mixed with 1 ml of 25 %dextrose) and Group B received 2.5 ml of 0.5% hyperbaric bupivacaine. Both the groups were compared in terms of onset of sensory and motor block, regression of sensory and motor block, duration of analgesia and side effects. Results: The onset of sensory block was comparable in both groups but was statistically insignificant. The onset of motor block in Bupivacaine(7.53 ± 1.72) min was faster when compared to Ropivacaine group(14.33 ± 6.19) min. Regression of sensory and motor block both were faster in Ropivacaine group. Duration of analgesia was longer in Bupivacaine group(131.17 ± 32.95)min than Ropivacaine group(125.33 ± 30.54)min. Conclusion: Ropivacaine can be used as an alternative to Bupivacaine for spinal anesthesia in cesarean section but has a shorter duration of sensory and motor block.

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Cerebrospinal Fluid Density Influences Extent of Plain Bupivacaine Spinal Anesthesia

Anesthesiology ◽

10.1097/00000542-200206000-00010 ◽

2002 ◽

Vol 96 (6) ◽

pp. 1325-1330 ◽

Cited By ~ 21

Author(s):

Eduardo Schiffer ◽

Elisabeth Van Gessel ◽

Roxane Fournier ◽

Anne Weber ◽

Zdravko Gamulin

Keyword(s):

Cerebrospinal Fluid ◽

Spinal Anesthesia ◽

Inverse Correlation ◽

Sensory Block ◽

Spinal Block ◽

Fluid Density ◽

Interindividual Variations ◽

Block Level ◽

Density Values ◽

Lateral Decubitus

Background The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia. Methods Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured. Results A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R(2) = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mM (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R(2) = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4. Conclusion These findings indicate an influence of cerebrospinal fluid density on subarachnoid distribution of 3 ml plain bupivacaine 0.5% and show that with higher cerebrospinal fluid densities, a higher spinal block level can be expected.

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Influence of Lumbosacral Cerebrospinal Fluid Density, Velocity, and Volume on Extent and Duration of Plain Bupivacaine Spinal Anesthesia

Anesthesiology ◽

10.1097/00000542-200401000-00019 ◽

2004 ◽

Vol 100 (1) ◽

pp. 106-114 ◽

Cited By ~ 85

Author(s):

Hideyuki Higuchi ◽

Jyun-ichi Hirata ◽

Yushi Adachi ◽

Tomiei Kazama

Keyword(s):

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Spinal Anesthesia ◽

Onset Time ◽

Inverse Correlation ◽

Sensory Block ◽

Magnetic Resonance Images ◽

Spinal Block ◽

Linear Regression Models ◽

Block Level

Background The current study was designed to investigate the influence of lumbosacral cerebrospinal fluid (CSF) density, velocity, and volume on the extent and duration of plain bupivacaine spinal anesthesia. Methods Forty-one patients scheduled to undergo orthopedic surgery with spinal block were enrolled. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images. CSF velocity at the L3-L4 level was derived from phase-contrast magnetic resonance images. Spinal anesthesia was performed in the lateral decubitus position. CSF (2 ml) was sampled to measure CSF density before injection of 3 ml plain bupivacaine (0.5%). Statistical correlation coefficients (rho) between CSF characteristics and measurements of spinal anesthesia were assessed by Spearman rank correlation. In addition, stepwise multiple linear regression models were used to select important predictors of measures of spinal anesthesia. Results There was a significant correlation between CSF density and peak sensory block level (rho = 0.33, P = 0.034). Lumbosacral CSF volume inversely correlated with peak sensory block level (rho = -0.65, P < 0.0001) and positively correlated with onset time of complete motor block (rho = 0.42, P = 0.008). CSF volume also inversely correlated with time required for regression of the sensory block to L1 (rho = -0.35, P = 0.026) and L2 (rho = -0.33, P = 0.039). There was a significant inverse correlation between peak diastolic CSF velocity and duration of motor blockade (rho = -0.44, P = 0.005). Multiple regression analysis revealed that weight and CSF volume significantly contributed to the peak sensory block level (R2 = 0.46). Conclusions These findings indicate that CSF density and volume influence the spread of spinal anesthesia with plain bupivacaine and that CSF volume also influences the duration of spinal anesthesia. CSF velocity might also influence the duration of plain bupivacaine spinal anesthesia.

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