[Determination of spinal or epidural anesthetic level in patients who cannot communicate well--finger or magnifying glass]

Difficulty to determine level of spinal or epidural anesthesia troubles us in the patients who can not communicate well, for example in patients with hearing loss, depressed CNS with or without depressants and in slowly replying patients with various reasons. We know that one can determine spinal or epidural anesthetic level with stroking the skin with finger with which we can detect different touch sensation, feeling as anesthetized smooth and unanesthetized rough. We thought that different touch sensation is due to perspiration at unblocked skin area. If cause of difference of touch sensation was due to perspiration at unanesthetized area as we thought, perspiration may be visible on unblocked area. We found no perspiration but texture change on the anesthetized skin. We photographed the texture of the blocked skin, before and after spinal anesthesia. The skin texture after the block became shallow and widened. These texture changes give us different touch sensation, rough and scratched before and smooth after the block. We can easily differentiate the blocked from the unblocked skin area with finger or by magnifying glass by which the skin texture change is visible.