Title: Spinal anesthesia at L2-3 vs L3-4 levels: comparison of onset of block, maximum level of block and hemodynamic response in obstetric patients undergoing caesarian section
Authors: Shahzada G, S. Wajahat Andrabi, Shaiq H, Malla Sadiq M
DOI: https://dx.doi.org/10.18535/jmscr/v6i4.140
Abstract
Background and Aims: Today intrathecal anaesthesia is used for almost any procedure below umbilicus. The present study evaluated Spinal anesthesia at L2-3 vs L3-4 levels with comparison of onset of block, maximum level of block and hemodynamic response in obstetric patients undergoing caesarian section.
Methodology: The study was conducted on seventy patients of American Society of Anesthesiologists Grade I and II of age group 18–37 years, allocated to one of the two groups of thirty five patients each. Group I received spinal anaesthesia at L2-L3 and Group II received spinal anaesthesia at L3-L4. Patients were monitored for onset of sensory and motor block, total duration of sensory block, level of sensory block, intraoperative haemodynamic characteristics and VAS score.
Results: Demographic variables were comparable. The onset times of sensory and motor block were significantly shorter in group I (7.10±1.40), (9.45±1.30) than group II (9.50±1.30), (13.00±1.20). There was a significant difference between the two groups in achieving the height of sensory block in the first 30 minutes after intrathecal injection (p<0.001). The median height of the sensory block for patients in group I was T8 whereas in group II, it was T9. The incidence of hypotension showed no statistical difference (p>0.05) between the two groups. The severity of intra operative pain, estimated using a 10 cm VAS, was significantly higher (p=0.038) in group I than in the group II at the beginning of the caesarean section while in the later course of the surgery no statistical difference was found.
Conclusion: Intrathecal anaesthesia with hyperbaric bupivacaine administered in L2–3 interspace for caesarean section provides superior analgesia, significantly earlier onset of sensory and motor block and equal hemodynamic stability as compared to spinal anaesthesia administered in the L3–4 interspace.
Keywords: Intrathecal anaesthesia, spinal, analgesia, hypotension, bradycardia, caesarean section.
