Scripties UMCG - Rijksuniversiteit Groningen
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Het effect van patiënt- en procedurele factoren op de sensorische zenuwblokkade bij spinale anesthesie

(2017) Mollinga, B.I.

Introduction: The spread of local anaesthetics within the cerebrospinal fluid (CSF) in spinal anaesthesia is influenced by at least 25 factors, which have highly unpredictable effects on block height. This study observed the effects of aspirating 10 ml CSF on the sensory block height directly before the injection of the spinal anaesthetic, as well as the potential influence the level of glucose in the CSF might have on the block height.
Materials & methods: The Anaesthetic Biobank of Cerebrospinal Fluid (ABC) has been aspirating 10 ml of CSF from patients about to receive spinal anaesthesia. For every ABC patient enrolled, a control patient was included to the database. Univariate and multiple linear regression analysis was conducted to determine the relationship between sensory block height and the variables age, body mass index (BMI), puncture position, volume of anaesthetics administered and volume of CSF aspirated.
Results: No significant difference was found in the block height between the patients in the ABC and the control group (P=0,311). Univariate linear regression showed that there was a significant relation between the puncture position and the block height (b=1,004; P=0,027). Multiple linear regression analysis showed that all variables could be omitted without it influencing the block height (P>0,064). The level of glucose in the CSF and the block height was not significantly different between diabetic and non-diabetic patients (P=0,925).
Conclusions: The variables age, BMI, puncture position, volume of anaesthetic and volume of aspiration do not have a significant influence on the sensory blockheight. The aspiration of 10 ml CSF before spinal anaesthesia does not increase the incidence of complications and does not result in excessive spread of the anaesthetic, nor should the dosage of the anaesthetic be adjusted when CSF is being aspirated. No conclusion can be drawn about the influence of glucose on the block height because the number of patients with high levels of glucose in their CSF was too small.

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