Document Detail

Predictors of successful neuraxial block: a prospective study.
MedLine Citation:
PMID:  12094920     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVE: The epidural and subarachnoid spaces should be identified at the first attempt, since multiple punctures increase the risk of postdural puncture headache, epidural haematoma and neural trauma. The study aimed to describe the predictors of successful neuraxial blocks at the first attempt. METHODS: After institutional Review Board approval, 1481 patients undergoing spinal or epidural anaesthesia were prospectively enrolled. For each block we recorded: gender, age, height, weight, body habitus, anatomical landmarks (palpability of the spinous processes), spinal anatomy, patient positioning, premedication, needle type and gauge, approach, spinal level of the block, and the provider's level of experience. Retrieval of cerebrospinal fluid or loss of resistance to saline or air identified the subarachnoid and epidural spaces, respectively. The outcome variable was the first attempt success or failure (whether or not the needle was correctly located with one skin puncture and produced adequate surgical anaesthesia). Backward stepwise logistic regression tested its association with the other variables. RESULTS: The first-attempt rate of success was 61.51%. Independent predictors (Odds ratio, 95% confidence limits) were the quality of anatomical landmarks (1.92 (1.57; 2.35)), the provider's level of experience (1.24 (1.15; 1.33)) and the adequacy of patient positioning (3.84 (2.84; 5.19)). CONCLUSIONS: The successful location of the subarachnoid or the epidural space at the first attempt is influenced by the quality of patients' anatomical landmarks, the adequacy of patient positioning and the provider's level of experience.
G R Oliveira de Filho; H P Gomes; M H Z da Fonseca; J C Hoffman; S G Pederneiras; J H S Garcia
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  19     ISSN:  0265-0215     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-07-03     Completed Date:  2003-02-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  447-51     Citation Subset:  IM    
Hospital Governador Celso Ramos, Department of Anaesthesiology, Florianópolis, SC, Brazil.
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MeSH Terms
Aged, 80 and over
Anesthesia, Epidural / methods*
Anesthesia, Spinal / methods*
Anesthesiology / education
Clinical Competence
Logistic Models
Middle Aged
Nerve Block / methods*,  statistics & numerical data
Odds Ratio
Prospective Studies
Risk Factors
Spine / anatomy & histology

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