WHAT IS YOUR UNDERSTANDING OF SPINAL AND EPIDURAL ATTEMPT?
Background: The practice of spinal and epidural anaesthesia is well established the world over for a number of years. Sighting of spinal or epidural is conducted through various approaches at various levels of the spinal column. The number of attempts has its correlation with the post-spinal and epidural complications.
Aim: The aim is to gather information about the understanding among the anaesthetists about the spinal/epidural attempt.
Materials and Methods: A pro forma comprising of nine closed-loop questions was distributed to all the participants in the study, and they were requested to fill it anonymously and placed it back in a designated sealed box in anaesthetic office.
Results: A total of 20 pro formas were distributed, and all of them received back with 100% responses. All the participants accepted universally that attempting through another space makes it a second attempt. One of the respondents thought any backward movement means 2nd attempt, the majority of the responders thought it does not count as an attempt. Almost everyone considered another attempt if a needle is completely withdrawn and enters through another puncture site whether through a midline or paramedian approach.
Conclusion: Most of the complications after neuraxial blockade are associated with the number of attempts alongside other factors that may play a role. A universal definition of a spinal and epidural attempt may decrease the complications associated with the central neuraxial blockade.
Key words: Epidural, single attempt, spinal
Gogarten W, Vandermeulen E, Van Aken H, et al. Regional anaesthesia and antithrombotic agents: Recommendations of the European society of anaesthesiology. Eur J Anaesthesiol 2010;27:999-1015.
Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American society of regional anesthesia and pain medicine evidence-based guidelines (Third edition). Reg Anesth Pain Med 2010;35:64-101.
Horlocker TT. Regional anaesthesia in the patient receiving antithrombotic and antiplatelet therapy. Br J Anaesth 2011;107 Suppl 1:96-106.
Manchikanti L, Falco FJ, Benyamin RM, et al. Assessment of bleeding risk of interventional techniques: A best evidence synthesis of practice patterns and perioperative management of anticoagulant and antithrombotic therapy. Pain Physician 2013;16:SE261-318.
Benzon HT, Avram MJ, Green D, et al. New oral anticoagulants and regional anaesthesia. Br J Anaesth 2013;111 Suppl 1:96-113.
Benzon HT, McCarthy RJ, Benzon HA, et al. Determination of residual antiplatelet activity of clopidogrel before neuraxial injections. Br J Anaesth 2011;107:966-71.
Sprung J, Bourke DL, Grass J, et al. Predicting the difficult neuraxial block: A prospective study. Anesth Analg 1999;89:384-9.
de Filho GR, Gomes HP, da Fonseca MH, et al. Predictors of successful neuraxial block: A prospective study. Eur J Anaesthesiol 2002;19:447-51.
Karraz MA. Primary score predicting the difficulty of neuraxial block. Anesth Analg 2002;94:476-7.
Rajakulendran Y, Rahman S, Venkat N. Long-term neurological complication following traumatic damage to the spinal cord with a 25 gauge whitacre spinal needle. Int J Obstet Anesth 1999;8:62-6.
Ronal DM, Lars IE, Lee AF, et al. Miller’s Anesthesia. 7th ed. USA: Elsevier; 2010.
John FB, David CM, John DW. Morgan and Mikhail’s Clinical Anesthesiology. 5th ed. USA: Mc-Graw Hill Education, Lange; 2013. p. 940-53.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors retain copyright and grant the Journal of Cancer & Allied Specialties (JCAS) right-of-first publication. In addition, the work will be simultaneously licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license. This license allows others to share the work in whole or part (for non-commercial purpose), with an acknowledgement of the work’s authorship and initial publication in JCAS.
Furthermore, authors are free to enter into separate contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
Authors are permitted and encouraged to share their work online or in medical or scientific conferences prior to or during submission process.