Abstract
Purpose
To determine if the extent of sensory blockade after the intrathecal injection of hypobaric fentanyl (25 μg) and bupicavaine (2.5 mg) in the sitting position in term parturients is influenced by body habitus.
Methods
A prospective observational study in 245 term parturients who received intrathecal fentanyl and bupivacaine plus an epidural test dose to initiate labour analgesia at an academic university hospital. The highest sensory blockade to ice and pinprick was determined at 15 and 30 min after the intrathecal injection. Correlations between sensory blockade and parturient height, weight and body mass index (BMI) were determined.
Results
There was no association between highest sensory blockade and parturients’ height. Increasing weight and BMI were associated with increased cephalad sensory blockade at 15 min, but not at 30 min. The estimated difference in sensory level between women at the extremes of BMI, based on our linear regression model, was less than one dermatome.
Conclusion
Height did not influence the extent of sensory analgesia after initiation of intrathecal labour analgesia using a hypobaric solution injected with the parturient in the sitting position. Weight and BMI were associated with a non-clinically significant increase in the cephalic spread of analgesia, suggesting that dose adjustments based on body habitus in this population are not necessary.
Résumé
Objectif
Déterminer si l’étendue du blocage sensitif, suivant l’injection intrathécale de fentanyl (25 μg) et de bupivacaïne (2,5 mg) hypobares en position assise chez des parturientes à terme, est influencée par l ’habitus corporel.
Méthode
Une étude par observation a été menée dans un centre hospitalier universitaire auprès de 245 parturientes à terme qui ont reçu du fentanyl et de la bupivacaïne intrathécaux en plus d’une dose test épidurale pour amorcer l’analgésie du travail. Le blocage sensitif maximal à la glace et à la piqûre d’épingle a été déterminé à 15 et 30 min après l’injection intrathécale. Les corrélations entre le blocage sensitif et la taille, le poids et l’index de masse corporelle (IMC) de la parturiente ont été déterminées.
Résultats
Aucun lien n’a été trouvé entre l’intensité du blocage sensitif et la taille de la patiente. Une hausse de poids et d’IMC a été associée à une hausse du blocage sensitif en direction céphalique à 15 min, non à 30 min. La différence estimée de niveau sensitif entre les femmes d’IMC extrêmes, fondée sur notre modèle de régression linéaire, a été de moins d’un dermatome.
Conclusion
La taille ne modifie pas l’étendue de l’analgésie sensitive qui suit l’injection intrathécale d’une solution hypobare chez les parturientes en position assise. Le poids et l’IMC sont associés à une hausse non cliniquement significative de l’extension de l’analgésie en direction céphalique, d’où la suggestion que des ajustements de la dose à l’habitus corporel ne soient pas nécessaires chez cette population.
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Wong, C.A., Cariaso, D., Johnson, E.C. et al. Body habitus does not influence spread of sensory blockade after the intrathecal injection of a hypobaric solution in term parturients. Can J Anaesth 50, 689–693 (2003). https://doi.org/10.1007/BF03018711
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DOI: https://doi.org/10.1007/BF03018711