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Predicting the difficult neuraxial block: a prospective study.

J Sprung1, D L Bourke, J Grass

  • 1Department of General Anesthesiology, Cleveland Clinic Foundation, OH 44195, USA. sprungj@cesmtp.ccf.org

Anesthesia and Analgesia
|August 10, 1999
PubMed
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Predicting difficult neuraxial blocks is crucial for anesthesiologists. Good spinal landmarks and normal anatomy are key indicators of easier neuraxial (spinal or epidural) blockade procedures.

Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Medical Procedure Optimization

Background:

  • Anticipated technical difficulty influences anesthesiologists' decisions for neuraxial blockade.
  • Neuraxial procedures carry risks including patient dissatisfaction and neurologic sequelae.

Purpose of the Study:

  • To identify patient characteristics that predict technical difficulty in performing neuraxial blocks.
  • To enhance the safety and efficiency of spinal and epidural anesthesia.

Main Methods:

  • A study of 595 neuraxial blocks was conducted.
  • Patient data included demographics, body habitus, spinal landmark quality, and spinal anatomy.
  • Technical difficulty was measured by first-level success and number of attempts.

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Main Results:

  • Quality of spinal landmarks was the strongest predictor of technical difficulty.
  • Abnormal spinal anatomy and body habitus also correlated with increased difficulty (number of attempts).
  • Age, sex, approach, needle type, gauge, and provider training level did not significantly predict difficulty.

Conclusions:

  • Patient's back examination for landmark quality and anatomical deformity is superior to body habitus for predicting neuraxial block difficulty.
  • Thoracic epidurals were found to be less difficult than lumbar epidurals.