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Acute reduction of cerebrospinal fluid volume prior to spinal anesthesia : implications for sensory block extent

Bjurström, Martin F. LU ; Mattsson, Niklas LU orcid ; Harsten, Andreas LU ; Dietz, Nicholas and Bodelsson, Mikael LU (2020) In Minerva Anestesiologica 86(6). p.636-644
Abstract

BACKGROUND: Multiple patient and clinical characteristics contribute to the variable outcome of spinal anesthesia (SPA). Acute reduction of cerebrospinal fluid (CSF) volume may alter the effect of SPA. The objective of the present study was to test if aspiration of 10 mL CSF immediately prior to SPA is associated with higher extent of sensory block. METHODS: Interventional cohort study. One hundred and two patients undergoing total hip arthroplasty (THA) were included. Fifty-one patients underwent sampling of 10 mL CSF prior to SPA (CSF aspiration group); 51 consecutive patients were used as controls. The primary outcome was the extent of sensory block to cold stimulus 20 minutes after injection of hyperbaric bupivacaine. Secondary... (More)

BACKGROUND: Multiple patient and clinical characteristics contribute to the variable outcome of spinal anesthesia (SPA). Acute reduction of cerebrospinal fluid (CSF) volume may alter the effect of SPA. The objective of the present study was to test if aspiration of 10 mL CSF immediately prior to SPA is associated with higher extent of sensory block. METHODS: Interventional cohort study. One hundred and two patients undergoing total hip arthroplasty (THA) were included. Fifty-one patients underwent sampling of 10 mL CSF prior to SPA (CSF aspiration group); 51 consecutive patients were used as controls. The primary outcome was the extent of sensory block to cold stimulus 20 minutes after injection of hyperbaric bupivacaine. Secondary outcome measures included duration of motor block and incidence of failed SPA. RESULTS: Acute reduction of CSF volume by 10 mL increased the extent of sensory anesthesia (mean thoracic level [T] 4.3±2.4 vs. 7.1±2.6, P<0.001). There were no significant between-group differences regarding motor block duration (P≥0.30) or failed SPA (three of 51 [CSF aspiration group] vs. one of 51 [control group], P=0.31). In a retrospective data analysis, 10 of 13 patients in the CSF aspiration group who had previously received SPA had a higher sensory block after 10 mL CSF aspiration compared to the previous SPA (T4.1 [range, 0-11] vs. T8.2 [4-10], P<0.01). CONCLUSIONS: Acute reduction of CSF volume by 10 mL prior to SPA leads to a higher thoracic level of sensory block.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Minerva Anestesiologica
volume
86
issue
6
pages
9 pages
publisher
Edizioni Minerva Medica S.p.A.
external identifiers
  • pmid:32013330
  • scopus:85087465568
ISSN
1827-1596
DOI
10.23736/S0375-9393.20.14138-5
language
English
LU publication?
yes
id
2b862ce4-75fc-423d-9aaa-ea44199020eb
date added to LUP
2020-07-16 12:47:30
date last changed
2024-05-01 13:57:48
@article{2b862ce4-75fc-423d-9aaa-ea44199020eb,
  abstract     = {{<p>BACKGROUND: Multiple patient and clinical characteristics contribute to the variable outcome of spinal anesthesia (SPA). Acute reduction of cerebrospinal fluid (CSF) volume may alter the effect of SPA. The objective of the present study was to test if aspiration of 10 mL CSF immediately prior to SPA is associated with higher extent of sensory block. METHODS: Interventional cohort study. One hundred and two patients undergoing total hip arthroplasty (THA) were included. Fifty-one patients underwent sampling of 10 mL CSF prior to SPA (CSF aspiration group); 51 consecutive patients were used as controls. The primary outcome was the extent of sensory block to cold stimulus 20 minutes after injection of hyperbaric bupivacaine. Secondary outcome measures included duration of motor block and incidence of failed SPA. RESULTS: Acute reduction of CSF volume by 10 mL increased the extent of sensory anesthesia (mean thoracic level [T] 4.3±2.4 vs. 7.1±2.6, P&lt;0.001). There were no significant between-group differences regarding motor block duration (P≥0.30) or failed SPA (three of 51 [CSF aspiration group] vs. one of 51 [control group], P=0.31). In a retrospective data analysis, 10 of 13 patients in the CSF aspiration group who had previously received SPA had a higher sensory block after 10 mL CSF aspiration compared to the previous SPA (T4.1 [range, 0-11] vs. T8.2 [4-10], P&lt;0.01). CONCLUSIONS: Acute reduction of CSF volume by 10 mL prior to SPA leads to a higher thoracic level of sensory block.</p>}},
  author       = {{Bjurström, Martin F. and Mattsson, Niklas and Harsten, Andreas and Dietz, Nicholas and Bodelsson, Mikael}},
  issn         = {{1827-1596}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{636--644}},
  publisher    = {{Edizioni Minerva Medica S.p.A.}},
  series       = {{Minerva Anestesiologica}},
  title        = {{Acute reduction of cerebrospinal fluid volume prior to spinal anesthesia : implications for sensory block extent}},
  url          = {{http://dx.doi.org/10.23736/S0375-9393.20.14138-5}},
  doi          = {{10.23736/S0375-9393.20.14138-5}},
  volume       = {{86}},
  year         = {{2020}},
}