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Assessment of spinal block adequacy

Annotation

This research presents a literature analysis of methods for evaluating the effectiveness of spinal anesthesia. The purpose of this analysis is to draw the attention of anesthesiologists to the issue of assessing the adequacy of neuraxial blockade and, in particular, spinal anesthesia, as the most commonly performed anesthetic management of surgical interventions. The adequacy of spinal anesthesia implies a pronounced motor block, which allows achieving complete relaxation of the muscles of the lower extremities and, if necessary, the muscles of the anterior abdominal wall, as well as the loss of pain, temperature and, as the most optimal level, this is the loss of tactile sensitivity. Considered methods for assessing motor, sensory and sympathetic blockade are P.R. Bromage scale to assess motor block, assessment of temperature and pain sensitivity (test with an ice tube, so-called Cold-test, test for pain sensitivity of the skin pin-prick). Until recently, in anesthesia practice, insufficient attention was paid to assessing the level of sympathetic blockade. The research describes an alternative method for assessing this type of blockade: laser doppler flowmetry. The quality and adequacy of spinal anesthesia will depend on the level and severity of these types of blockades.

Keywords

spinal anesthesia; motor blockade; sensory blockade; sympathetic blockade

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DOI

10.20310/2782-5019-2023-5-3-59-66

UDC

616.832-009.614

Pages

59-66

References

1. Yamshchikov O.N., Marchenko A.P., Emelyanov S.A., Cherkaeva A.V., Ignatova M.A. History of application of local anesthetics for neuroaxial blocks. Avicenna Bulletin. 2021;23(3):432-42. (In Russian). DOI 10.25005/2074-0581-2021-23-3-432-442 2. Koryachkin V.A., Glushchenko V.A., Strashnov V.I. Regional anesthesia: combined spinal-epidural anesthesia. Anesthesiology and Intensive Care. 2007;(5):72-74. (In Russian). 3. Koryachkin V.A. Neuroaxial Blockade. Moscow; 2015. (In Russian). 4. Kazakov Yu.I., Federyakin D.V., Ovezov A.M., Kozachuk A.V. Method for determining the sympathetic component of the block during the development of spinal anesthesia, pat. RU no. 2481865 C1. IPC A61M 19/00, A61B 5/02; publ. 20.05.2013. (In Russian). 5. Armstrong P. Unilateral subarachnoid anaesthesia. Anaesthesia. 1989;44:918-919. 6. Barker A. A report on clinical experience with spinal analgesia in 100 cases, and some reflections on the procedure. Br. Med. J. 1907 Mar 23;1(2412):665-674. DOI 10.1136/bmj.1.2412.665 7. Carpenter R., Hogan Q., Liu S. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology. 1998;89:24-29.

Received

2023-07-19

Section of issue

Clinical medicine

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