Factors predicting difficult spinal block: A single centre study.

Area of Science:

• Anesthesiology
• Neurosurgery
• Spinal Anesthesia

Background:

• Dural puncture success is crucial for spinal anesthesia.
• Factors influencing first attempt success and total attempts are not fully understood.

Purpose of the Study:

• To assess patient, provider, technique, and equipment factors associated with first dural puncture success.
• To identify predictors for the number of attempts required for successful dural puncture.

Main Methods:

• Prospective observational study of 1647 adult patients undergoing spinal anesthesia.
• Data collected on patient characteristics, anatomical landmarks, provider experience, and procedural details.
• Difficult dural puncture defined by first puncture success and number of attempts.

Main Results:

• First puncture success rate was 52.9%.
• Factors associated with first puncture success included longer C7-coccyx distance, lower subarachnoid depth, good bony landmarks, and absence of spinal crowding.
• Male gender, poor landmarks, bony deformity, and less experienced providers predicted more attempts.

Conclusions:

• Patient anatomical factors solely influence first dural puncture success.
• Both patient and provider factors predict the number of attempts for successful spinal block.