Correlation between anthropometric measurements and sensory block level of spinal anesthesia for cesarean section

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.

Broken Spinal Needle in a Morbidly Obese Parturient Presenting for Urgent Cesarean Section

Neuraxial anesthesia has become the preferred method of anesthesia for nonemergent cesarean delivery and cases where regional anesthesia is not contraindicated. Multiple cases of broken spinal and epidural needles have been reported in the literature over the last several years; however, the specific incidence of needle breakage is still unknown. Less reliance on general anesthesia and increasing parturient body mass index (BMI) has likely contributed to more reports of broken needles during regional anesthesia for obstetric surgery. We describe a case of a broken spinal needle after attempted spinal anesthetic placement for cesarean delivery in a morbidly obese parturient, subsequent postoperative management, and current treatment recommendations.

Effect of silodosin in post operative retention of urine

Background: Post-operative urinary retention (POUR) is a common yet potentially serious morbidity with a reported incidence of 3 to 25%. This study aims to evaluate the effect of Silodosin, a super-selective alpha- 1a adrenergic blocking agent, as prophylaxis for post operative urinary retention in patients undergoing various surgical procedures.Methods: 100 patients were divided into two groups of 50 each. In group 1, patients were given prophylactic silodosin to evaluate its effect in post operative retention of urine and in group 2, patients were not given any medication.Results: In this study, POUR was diagnosed. POUR was higher in the older age group i.e. more in the age group of 41-60 yrs but in group 1, it was less as compared to group 2. POUR rate in general anaesthesia (GA) patients are less (11.1%) in group 1 as compared to (23.6%) in group 2. POUR rate in spinal anaesthesia (SA) patients are more (21.4%) in group 1 as compared (16.6%) in group 2. The total POUR rate in group 1 was lower (14%) as compared to (22%) in group 2.Conclusions: In our opinion patients operated under GA, irrespective of gender and type of surgery will benefit from prophylactic silodosin given in pre-operative period for the prevention of POUR and we highly recommend this. Patients who were operated under SA were not benefitted by giving prophylactic silodosin. Probably this is due to use of long acting spinal anesthetic agent in the form of bupivacaine in our patients.

A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion: technical note

Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is associated with improved patient-reported outcomes in well-selected patients. Recently, some neurosurgeons have aimed to further improve outcomes by utilizing multimodal methods to avoid the use of general anesthesia. Here, the authors report on the use of a novel awake technique for MI-TLIF in two patients. They describe the successful use of liposomal bupivacaine in combination with a spinal anesthetic to allow for operative analgesia.