Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection
Introduction: Spinal Anaesthesia (SA) has stood as the most favoured and dependable technique in regional anaesthesia for the past century. However, despite its widespread use, there are instances of occasional SA failure. Currently, there is no straightforward, cost-effective, and easily admini...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2024-01-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://www.jcdr.net/articles/PDF/18977/68683_CE[Ra1]_QC(NA)_F[SK]_PF1(AKA_DK_SHU)_PFA(AKA_KM)_PN(KM).pdf |
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| author | Sandip Krishnaraj Patil Supriya Praful rawate Zeenal Punamiya |
| author_facet | Sandip Krishnaraj Patil Supriya Praful rawate Zeenal Punamiya |
| author_sort | Sandip Krishnaraj Patil |
| collection | DOAJ |
| description | Introduction: Spinal Anaesthesia (SA) has stood as the most
favoured and dependable technique in regional anaesthesia
for the past century. However, despite its widespread use,
there are instances of occasional SA failure. Currently, there
is no straightforward, cost-effective, and easily administered
real-time test-aside from the positive aspiration of Cerebrospinal
Fluid (CSF)-that can reliably confirm the deposition of local
anaesthetic in the subarachnoid space.
Aim: To evaluate the predictive value of subjective sensations
(warmth/tingling/numbness) during the administration of SA for
enhancing success rates.
Materials and Methods: A prospective observational study
preceeded the recruitment of 500 patients for this investigation.
Following the confirmation of CSF aspiration upon injecting the SA
drug, Bupivacaine, patients were queried about the sensations of
warmth and/or tingling numbness in the lower limb, saddle part,
and inner thighs. This assessment was conducted at 30 seconds
and one minute after injection. Additionally, patients were asked to
report any increase in the area and/or intensity of these sensations.
The adequacy of SA was determined by achieving a sensory
block upto the desired dermatome level and reaching a Bromage
scale score of IV. Evaluations were performed at two minutes, five
minutes, 10 minutes, and 15 minutes from the initiation of SA.
Results: The population, predominantly ASA Class-I (60%) and II
(40%), exhibited a median age of 45 years, with 54% being male.
Intraoperative vital signs, including Heart Rate (HR), Systolic
Blood Pressures (SBP), and Diastolic Blood Pressures (DBP),
showed a consistent declining trend post-SA administration.
Efficacy assessments revealed that Bromage Grade-IV was
achieved in 99% of patients at 15 minutes. Notably, subjective
sensations of warmth, tingling, and/or numbness proved to be
robust predictors of successful SA, with a 218-fold increased
likelihood. The diagnostic model demonstrated a high sensitivity
of 98%, specificity of 85%, and a Positive Predictive Value (PPV)
exceeding 99%.
Conclusion: This study highlights the crucial role of warmth,
tingling, and numbness as reliable indicators for successful
SA, supported by a robust 97% success rate. Incorporating
these patient-reported sensations in assessments provides a
practical and accessible approach to improve the efficacy of
SA procedures. |
| first_indexed | 2024-03-08T12:23:52Z |
| format | Article |
| id | doaj.art-0e5fecf4339e49f1adad621a1c867a56 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-08T12:23:52Z |
| publishDate | 2024-01-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-0e5fecf4339e49f1adad621a1c867a562024-01-22T11:02:02ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2024-01-011801434710.7860/JCDR/2024/68683.18977Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug InjectionSandip Krishnaraj Patil0Supriya Praful rawate1Zeenal Punamiya2Consultant Anaesthesiologist, Department of Anaesthesia, Maharashtra Medical Foundation Hospital Association, Pune, Maharashtra, India.Consultant Anaesthesiologist, Department of Anaesthesia, Maharashtra Medical Foundation Hospital Association, Pune, Maharashtra, India.Program manager, Medical Innovation Creativity and Entrepreneurship (M.I.C.E.).Labs ,Grant Government Medical College and Sir JJ Hospitals , Mumbai, Maharashtra, India.Introduction: Spinal Anaesthesia (SA) has stood as the most favoured and dependable technique in regional anaesthesia for the past century. However, despite its widespread use, there are instances of occasional SA failure. Currently, there is no straightforward, cost-effective, and easily administered real-time test-aside from the positive aspiration of Cerebrospinal Fluid (CSF)-that can reliably confirm the deposition of local anaesthetic in the subarachnoid space. Aim: To evaluate the predictive value of subjective sensations (warmth/tingling/numbness) during the administration of SA for enhancing success rates. Materials and Methods: A prospective observational study preceeded the recruitment of 500 patients for this investigation. Following the confirmation of CSF aspiration upon injecting the SA drug, Bupivacaine, patients were queried about the sensations of warmth and/or tingling numbness in the lower limb, saddle part, and inner thighs. This assessment was conducted at 30 seconds and one minute after injection. Additionally, patients were asked to report any increase in the area and/or intensity of these sensations. The adequacy of SA was determined by achieving a sensory block upto the desired dermatome level and reaching a Bromage scale score of IV. Evaluations were performed at two minutes, five minutes, 10 minutes, and 15 minutes from the initiation of SA. Results: The population, predominantly ASA Class-I (60%) and II (40%), exhibited a median age of 45 years, with 54% being male. Intraoperative vital signs, including Heart Rate (HR), Systolic Blood Pressures (SBP), and Diastolic Blood Pressures (DBP), showed a consistent declining trend post-SA administration. Efficacy assessments revealed that Bromage Grade-IV was achieved in 99% of patients at 15 minutes. Notably, subjective sensations of warmth, tingling, and/or numbness proved to be robust predictors of successful SA, with a 218-fold increased likelihood. The diagnostic model demonstrated a high sensitivity of 98%, specificity of 85%, and a Positive Predictive Value (PPV) exceeding 99%. Conclusion: This study highlights the crucial role of warmth, tingling, and numbness as reliable indicators for successful SA, supported by a robust 97% success rate. Incorporating these patient-reported sensations in assessments provides a practical and accessible approach to improve the efficacy of SA procedures.https://www.jcdr.net/articles/PDF/18977/68683_CE[Ra1]_QC(NA)_F[SK]_PF1(AKA_DK_SHU)_PFA(AKA_KM)_PN(KM).pdfcerebrospinal fluidnumbnesstinglingwarmth |
| spellingShingle | Sandip Krishnaraj Patil Supriya Praful rawate Zeenal Punamiya Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection Journal of Clinical and Diagnostic Research cerebrospinal fluid numbness tingling warmth |
| title | Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection |
| title_full | Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection |
| title_fullStr | Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection |
| title_full_unstemmed | Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection |
| title_short | Spinal Anaesthesia Success: An Observational Study Assessing Subjective Sensations During Spinal Anaesthetic Drug Injection |
| title_sort | spinal anaesthesia success an observational study assessing subjective sensations during spinal anaesthetic drug injection |
| topic | cerebrospinal fluid numbness tingling warmth |
| url | https://www.jcdr.net/articles/PDF/18977/68683_CE[Ra1]_QC(NA)_F[SK]_PF1(AKA_DK_SHU)_PFA(AKA_KM)_PN(KM).pdf |
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