Comparison between Pendant Positions versus Traditional Sitting Positions for Successful Spinal Puncture in Patients Undergoing Caesarean Deliveries

Aim: To determine the effectiveness among pendant position and traditional sitting position in term of successful spinal puncture in patients underwent caesarean deliveries. Study Design: Randomized control trial Place and Duration of Study: Department of Anaesthesia, Ghurki Trust Teaching Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and eighty patients were included. Patient’s detailed demographics were recorded after taking written consent. Patients were aged between 20-50 years. Patients were equally divided into two groups, group I had 90 patients underwent pendant position and group II had 90 patients and underwent for traditional sitting. Randomly one of two positions was performed with the L3-L4 interface in spinal puncture. Time for successful spinal puncture, number of needle to bone contacts and total number of attempts were calculated. Results: Mean age of the patients in group I was 27.6±17.04 years with mean BMI 24.25±2.63 kg/m2 and in group II, mean age was 29.23±14.24 years with mean BMI 26.55±6.36 kg/m2. Mean height of patients in group I was 2.6524±1.0054 meter and in group II was 2.6516±1.0042 meter. Weight of the patients in group I 63.48±22.13 kg and in group II was 65.46±17.19 kg. Success rate after first attempt in group I was 80 (94.44%) and group II was 72 (80%). For spinal needle insertion, fewer mean times was observed in group I 19.55±11.221 sec as compared to group II 28.14±18.226 sec. Number of needle to bone contacts was higher 66.7% in group I and in group II 40%. Number of attempt was less in group I as compared to group II. Conclusion: The pendant position in the pregnant women who had a caesarean sector was much better than the standard position in order to provide the 1st attempt of spinal puncture. Keywords: Caesarean, Spinal anaesthesia, Traditional sitting, Pendant position

Comparison of the effects of sagittal versus transvers 25-gauge quincke needle insertion on post-dural puncture headache development

Objective: Post-dural puncture headache (PDPH) is one of the most important complications after spinal anesthesia. This study aimed to investigate the effect of the sagittal or transverse application of 25-gauge Quincke spinal needle on PDPH development in patients undergoing cesarean section. Material and Methods: A total of 295 patients with a planned cesarean section between the ages of 18-40 years with an American Society of Anesthesiologists score of 1 or 2 were included in the study. For the spinal intervention, 25-gauge Quincke spinal needle was used in all patients. Patients were included in one of two groups according to the spinal needle cutting direction of the dura mater fibers as sagittal (parallel to dura mater fibers, Group S; n=145) or transverse group (perpendicular to dura mater fibers, Group T; n=150). Results: PDPH developed in 27 (9.2%) patients. Patients in Group T had significant higher ratio of PDPH compared to patients in Group S (16% vs. 2.1%, p<0.001). Additionally, patients with PDPH had a significantly higher frequency of ≥2 spinal puncture attempts compared to patients without PDPH (22.2% vs. 4.5%, p=0.003). Multivariate logistic regression analysis demonstrated that transverse needle direction (OR: 11.40, 95% CI: 2.73-34.71; p<0.001) and ≥2 spinal puncture attempts (OR: 9.73, 95% CI: 3.13-41.55; p<0.001) and were independent predictors for PDPH development. Conclusion: Transverse insertion of the 25-gauge Quincke needle into spinal cord fibers and repeated interventions are independently associated with the development of PDPH in cesarean section patients undergoing spinal anesthesia

Comparison of successful spinal puncture between pendant position and traditional sitting position for cesarean deliveries

Background & objectives: Several positions are used for performing subarachnoid block with varying difficulty of spinal access. Pendant position is known to reduce lumbar lordosis in patients’ especially pregnant patients making spinal access easier. The most ideal position for the easy spinal access is yet to be determined. This study was planned to compare ease of spinal access in pendant position vs. traditional sitting position (TSP) in pregnant females, and to establish the superiority of the former. Methodology: This randomized controlled trial was conducted in our hospital on 232 subjects over 6 month period. Parturients undergoing elective lower segment cesarean section (LSCS) were randomly divided into two groups: Group A (pendant group) and Group B (TSP group). Spinal puncture was performed at L3-L4 interspace, randomly making one of the two positions. Time for successful spinal, number of needle-to-bone contacts and total number of attempts were recorded. Results: The median age of the patients was 29 yrs with the interquartile range (IQR) 7. The number of needle-to-bone contacts in Group A was significantly higher compared to Group B (59.48% vs. 33.62%, p = 0.000). Mean time for successful spinal puncture was less in Group A than Group B (17.69 sec vs. 25.54 sec, p = 0.001). The difference in number of attempts for spinal in both positions was not significant. Conclusion: Pendant position is better than traditional sitting position in achieving successful spinal puncture in terms of needle-to-bone contacts and the time to puncture. However there is no difference in number of attempts for both positions. Key words: Traditional sitting position; Pendant position; Spinal anesthesia; Cesarean section Citation: Arshad QUA, Jadoon H, Raza A, Furqan Z, Shahani YA. Comparison of successful spinal puncture between pendant position and traditional sitting position for cesarean deliveries. Anaesth. pain intensive care 2020;24(6):--- Received: 13 July 2020, Reviewed: 28 September 2020, Accepted: 29 September 2020

Influence of age, laterality, patient position, and spinal level on the interlamina space for spinal puncture

Background and objectivesThe lumbar interlamina space height is an important determinant of successful spinal puncture. We aimed to evaluate the influence of age, laterality, patient position, and spinal level on the height of the interlamina window using ultrasonography.MethodsUltrasonographic examination was performed in 20 adult patients aged under 40 years (group Y) and 20 patients aged over 60 years (group O). We set three primary outcomes: difference in the interlamina height of the ligamentum flavum-dura mater complex (LFD) according to (1) age, (2) laterality, and (3) position. For secondary outcomes, the degree of ultrasonography visualization (poor, intermediate, or good) and the depths from the skin to LFD and to anterior complex were also measured on right and left paramedian sagittal oblique view in both lateral and sitting positions at L3/4, L4/5, and L5/S1 levels. All variables were analyzed in association with age, laterality, patient position, and spinal level.ResultsThe interlamina height of LFD was higher, and the degree of visualization was better in group Y than in group O. It differed depending on laterality in paramedian sagittal oblique view images in the same patients at all spinal levels. The interlamina height of LFD was the largest at L5/S1 level in both groups. Position had little influence on the interlamina height of LFD.ConclusionsScanning both sides and all spinal levels before selecting a puncture site for ultrasound-guided spinal anesthesia is recommended. The L5/S1 spinal level is a good option for spinal puncture in the elderly.Trial registration numberNCT03929874.

Can an inflammatory reaction in the meninges, caused by spinal puncture through tattooed skin, evolve into adhesive arachnoiditis? An experimental model in rabbits

Background and objectivesAs the number of people with tattoos has been increasing, anesthesiologists are more and more faced with the decision to perform a neuraxial blockage through tattooed skin. In this study, we evaluated the possibility of puncture through tattooed skin determines acute inflammatory changes in the meninges and spinal cord and later evolve into adhesive arachnoiditis.MethodForty-two male rabbits were randomized into 3 groups of 14: G1, spinal puncture through non-tattooed skin and saline solution injection; G2, spinal puncture through tattooed skin and saline solution injection, captive for 30 days; G3, spinal puncture through tattooed skin and saline solution injection, captive for 360 days. The animals were anesthetized and ultrasound-guided spinal puncture was performed in the intervertebral spaces between S1 – S2. During the period of captivity, the animals were clinically assessed for sensitivity and motor function. After that, they were sacrificed and the lumbosacral portion of the spinal cord was excised for histological analysis.ResultsNo histological changes were found on group 1. Eleven animals from group two presented with foci of perivascular lymphocytic inflammatory infiltrate in the pia mater and/or arachnoid. In Group 3, eight rabbits presented with inflammatory changes in the meninges, which were associated with thickening and/or adhesion of the pia mater and arachnoid in some cases and five rabbits presented only thickening of pia-mater.ConclusionsSpinal puncture through tattooed skin of rabbits can trigger acute inflammatory changes in the meninges and after a prolonged period of observation evolve into adhesive arachnoiditis.

The Effect of Ginger on Preventing Post-spinal Puncture Headache in Patients Undergoing Cesarean Section

Objectives: Post-spinal puncture headache (PSPH) has constantly been one of the research priorities, especially in women undergoing cesarean section (C-section) and it is related to physical and psychological problems. The present study aimed to evaluate the effect of ginger on preventing PSPH in patients undergoing C-section. Materials and Methods: This clinical trial was conducted on 160 women undergoing C-section with spinal anesthesia, who were eligible to enter the study in the experimental and control groups. One ginger capsule (250 mg) was prescribed every 8 hours (TDS) to the experimental group 24 hours before the C-section. The prescription of ginger was continued half an hour after transfer to the post-partum ward until the PSPH onset. PSPH intensity was measured by using visual analog scale (VAS) pain scores at 6 timepoints (Time 1=30, Time 2=60, and Time 3=90 minutes vs. Time 4=3, Time 5 =6, and Time 6=12 hours) after C-section. No interventions were performed in the control group. The data were analyzed using the SPSS software by descriptive statistics and analytical tests were applied to determine the changes in PSPH intensity. Results: The comparison results of the mean score of PSPH intensity in the experimental and control groups indicated significant differences over time (P<0.05), except for the sixth time point (12 hours after C-section). In addition, the trend of changes at 6 timepoints based on the results of the repeated-measures test demonstrated that PSPH intensity significantly differed in the two groups over time (P<0.001). Conclusions: Based on the result, the oral prescription of ginger to women undergoing C-section under spinal anesthesia led to effective PSPH prevention at 5 time-points (30, 60, and 90 minutes, along with 3 and 6 hours). Further, the trend of the changes represented that the intensity of PSPH decreased in the experimental group over time. Therefore, ginger is suggested as a noninvasive and efficient method used for preventing PSPH.