Abstract
Background
Spinal anaesthesia performed at levels higher than the L3–4 intervertebral space may
result in spinal cord injury. Our aim was to establish a protocol to reduce the chance
of spinal anaesthesia performed at or above L2–3.
Methods
One hundred and ten consenting patients at 32 weeks of gestation or greater scheduled for non-emergency caesarean section under
spinal anaesthesia were randomly allocated to have needle insertion performed at an
intervertebral space determined by one of two landmark techniques. In Group A, if
the intercristal line intersected an intervertebral space, this space was selected
or if the intercristal line intersected a spinous process the space immediately above
was selected. In Group B, if the intercristal line intersected an intervertebral space
or a spinous process, the intervertebral space immediately below was chosen. The actual
intervertebral space chosen was identified using ultrasound by a blinded investigator.
Results
In Group A, an intervertebral space at or above L2–3 was marked in 25 (45.5%) patients
compared with 4 (7.3%) in Group B (P <0.001). In 5/55 (9.1%) patients in Group A, the intervertebral space initially chosen
was L1–2 whereas this occurred in no patient in Group B. There was no difference between
groups in number of needle passes or attempts, onset of block at 5, 10 and 15 min or need for rescue analgesia.
Conclusion
Our data suggest that when performing spinal anaesthesia in pregnant patients, if
the intercristal line intersects an intervertebral space then the space below should
be chosen and if the intercristal line intersects a spinous process then the interspace
below should be chosen. This will reduce the incidence of spinal anaesthesia performed
at or above L2–3.
Keywords
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Article info
Publication history
Published online: April 17, 2014
Accepted:
February 10,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
