Correlation Between Vertebral Column Length (VCL), Abdominal Circumference (AC) and Spread of Intrathecal Hyperbaric Bupivacaine in the Term Parturient
Description:
The rising rate of caesarean section is a global phenomenon. Rate of caesarean section in
Malaysia were 23.41% in 2011 and 25.08% in 2012. Subarachnoid block is the preferred
anaesthetic technique for most lower segment caesarean section as compared to general
anaesthesia. This is because general anaesthesia is associated with higher risk of failed
endotracheal intubation and aspiration of gastric contents in parturients. Moreover, usage of
pencil-point spinal needle had reduced the risk of postdural puncture headache frequency and
severity.
Effective surgical anaesthesia is the main objective of subarachnoid block. Therefore,
adequate sensory blockade with minimal maternal and neonate side effects are warranted. The
suitable level of sensory blockade post subarachnoid block for lower segment caesarean
section is bilateral block up to T6 dermatome level to pinprick. This will block the somatic
sensation and eliminate the visceral pain from peritoneal manipulation during caesarean
section.
However, the spread of subarachnoid block may be variable. Various patient variables such as
age, height, weight, body mass index, vertebral column length and abdominal girth influence
the spread of subarachnoid block. Inadequate sensory blockade will cause parturient suffer
from pain while excessive blockade will lead to unwanted sympathetic inhibition causing
hypotension and bradycardia. Ability of an anaesthetist to determine optimal dose to achieve
adequate level of sensory blockade yet with minimal unwanted side effects is crucial.
Incidence of maternal hypotension is related to the level of sensory blockade after
subarachnoid block.And maternal hypotension is associated with maternal discomfort during
caesarean section and poorer fetal outcomes. Therefore, this study is carried out to
investigate whether vertebral column length and abdominal circumference affecting the spread
of intrathecal hyperbaric bupivacaine in term parturient.
Previous studies showed conflicting results on the factors that influence the effect of
spinal anaesthesia. One of the studies was carried out in China which might not reflect the
investigator’s local multiracial population characteristics. Previous studies also did not
investigate the outcome of baby related to maternal hypotension which is known complication.
Condition:
Effects of; Anesthesia, Spinal and Epidural, in Pregnancy
Treatment:
subarachnoid block
Start Date:
August 21, 2018
Sponsor:
University of Malaya
For More Information:
https://clinicaltrials.gov/show/NCT03606525