Authors: Kari A Leino Kristiina S Kuusniemi Heikki K Pälve Hannu T Tiusanen Tapani T Tuppurainen
Publish Date: 2010/12/31
Volume: 25, Issue: 2, Pages: 213-218
Abstract
Body mass index BMI has a significant effect on the spread of sensory spinal block in rheumatoid patients We tried to achieve the same spread of spinal block for patients in three different BMI groups and on the basis of the results from a preliminary study used a simple method feasible for clinical practice We hypothesized that BMIrelated inverse dosing of plain bupivacaine according to low normal and high BMI would result in no difference in block extentTogether 75 patients with seropositive rheumatoid arthritis were included in three equalsized groups according to BMI low 23 kg/m2 normal 23–28 kg/m2 and high 28 kg/m2 Spinal anesthesia was induced with plain bupivacaine using doses 33 30 and 27 ml respectively The spread of sensory block was recorded 30 min after injection of bupivacaine by use of a pinprick test and a cold icefilled containerDespite threestep dosing of plain bupivacaine inversely related to BMI low normal or high comparable block extent was not achieved because of greater spread in the highBMI group Adjustment of plain bupivacaine dose according to BMI could be used to achieve a more predictable spread of spinal block but further reduction of dose is needed in patients with high BMI
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