Effect of Hip/Shoulder-Width Ratio on Sensory Blockade After Intrathecal Anesthesia for Adult Subumblical Herniorraphy

Overview

Spinal anesthesia is a straightforward and reliable technique frequently employed in lower body surgeries, achieving adequate surgical conditions through the injection of a small amount of local anesthetic (LA) into the intrathecal space . One advantage of spinal anesthesia over general anesthesia is reduced exposure to potentially depressant drugs . However, inadequate spinal spread can result in pain and discomfort for patients and complicate surgical procedures . Consequently, anesthesiologists encounter the challenge of attaining the proper spread of spinal anesthesia for subumbilical herniorrhaphy due to individual anthropometric variations . Approximately 25 factors have been identified that affect the spread of spinal anesthesia in the subarachnoid space for a given dose of LA . Variables that are both practically obtainable and predictive of spinal anesthesia spread can aid anesthesiologists in anticipating the extent of the block. Among the most studied factors are patient characteristics, injection techniques, patient posture, and the baricity of the LA . Research has examined various patient variables affecting spinal anesthesia spread, including age , weight , height , gender, patient position, BMI , vertebral column length (VCL), and abdominal circumference . Body morphometrics such as the hip-shoulder width ratio (HSWR) have garnered attention for their potential impact on the distribution of anesthetic agents within the intrathecal space . Despite the well-established influence of factors like age, weight, and spinal anatomy, the specific role of HSWR in the outcomes of intrathecal anesthesia remains underexplored this study aim to To evaluate the effect of hip/shoulder-width ratio (HSWR) on sensory blockade level after intrathecal anesthesia for adult patients undergoing subumblical herniorraphy

Detailed description

Spinal anesthesia is a straightforward and reliable technique frequently employed in lower body surgeries, achieving adequate surgical conditions through the injection of a small amount of local anesthetic (LA) into the intrathecal space . One advantage of spinal anesthesia over general anesthesia is reduced exposure to potentially depressant drugs . However, inadequate spinal spread can result in pain and discomfort for patients and complicate surgical procedures . Consequently, anesthesiologists encounter the challenge of attaining the proper spread of spinal anesthesia for subumbilical herniorrhaphy due to individual anthropometric variations .

Approximately 25 factors have been identified that affect the spread of spinal anesthesia in the subarachnoid space for a given dose of LA . Variables that are both practically obtainable and predictive of spinal anesthesia spread can aid anesthesiologists in anticipating the extent of the block. Among the most studied factors are patient characteristics, injection techniques, patient posture, and the baricity of the LA .

Research has examined various patient variables affecting spinal anesthesia spread, including age , weight , height , gender, patient position, BMI , vertebral column length (VCL), and abdominal circumference . Body morphometrics such as the hip-shoulder width ratio (HSWR) have garnered attention for their potential impact on the distribution of anesthetic agents within the intrathecal space . Despite the well-established influence of factors like age, weight, and spinal anatomy, the specific role of HSWR in the outcomes of intrathecal anesthesia remains underexplored

Interventions

• Procedure Hip/shoulder width ratio
  the effect of hip/shoulder-width ratio on sensory blockade level in patients undergoing intrathecal anesthesia for subumbilical herniorrhaphy

Primary outcome measures

• the sensory blockade level in patients undergoing intrathecal anesthesia for subumbilical herniorrhaphy. [Time frame: baseline]

Eligibility criteria

Inclusion criteria

• Age 20 - 50 years old
• Both sexes
• Patients who are in risk-scoring groups I-II of the American Society of Anesthesiologists (ASA)
• Elective subumblical herniorraphy under intrathecal anesthesia

Exclusion criteria

• • Patient refusal

• Patients have a contraindication for regional anesthesia, e.g. coagulopathy.
• Failed or unsatisfactory intrathecal block.
• Patients have a central nervous system disease (mental retardation, non-cooperated speech disorder, or psychiatric disease).
• Patients who are under 150 cm or over 185 cm in height, or BMI >40.
• Patients have experienced an operation lasting more than 2 h.
• Patients with known hypersensitivity to amide local anesthetics.
• Local injection site infection or spinal deformity.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Case-only

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Ngaka TC, Coetzee JF, Dyer RA. The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement During Spinal Anesthesia for Elective Cesarean Delivery. Anesth Analg. 2016 Dec;123(6):1527-1534. doi: 10.1213/ANE.0000000000001568. PMID 27870737
• Fu F, Xiao F, Chen W, Yang M, Zhou Y, Ngan Kee WD, Chen X. A randomised double-blind dose-response study of weight-adjusted infusions of norepinephrine for preventing hypotension during combined spinal-epidural anaesthesia for Caesarean delivery. Br J Anaesth. 2020 Mar;124(3):e108-e114. doi: 10.1016/j.bja.2019.12.019. Epub 2020 Jan 17. PMID 31959386
• Chen M, Chen C, Ke Q. The effect of age on the median effective dose (ED50) of intrathecally administered plain bupivacaine for motor block. Anesth Analg. 2014 Apr;118(4):863-8. doi: 10.1213/ANE.0000000000000147. PMID 24651241
• Zhou QH, Xiao WP, Shen YY. Abdominal girth, vertebral column length, and spread of spinal anesthesia in 30 minutes after plain bupivacaine 5 mg/mL. Anesth Analg. 2014 Jul;119(1):203-206. doi: 10.1213/ANE.0000000000000199. PMID 24806139
• Adesope OA, Einhorn LM, Olufolabi AJ, Cooter M, Habib AS. The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery. Int J Obstet Anesth. 2016 May;26:8-14. doi: 10.1016/j.ijoa.2016.01.007. Epub 2016 Feb 2. PMID 27020240
• Agegnehu AF, Gebregzi AH, Endalew NS. Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting. Int J Surg Open. 2020;26:101-105. doi: 10.1016/j.ijso.2020.08.013. Epub 2020 Sep 3. PMID 34568612
• Shivashankar A, Rajappa GC, Sudarshan S, Madhu MM, Rao R. Evaluation of Effect of Hip/Shoulder-Width Ratio on the Sensory Level of Spinal Anesthesia - A Prospective Observational Study. Anesth Essays Res. 2022 Jan-Mar;16(1):80-83. doi: 10.4103/aer.aer_146_21. Epub 2022 Jun 27. PMID 36249129

Identifiers

NCT: NCT06684548 · HS W Ratio Herniorraphy

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗