Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000300002
Brazilian Journal of Anesthesiology
Scientific Article

Identificação dos espaços interespinhosos lombares por palpação e avaliados por radiografias

Identification of the lumbar interspinous spaces by palpation and verified by X-rays

Kei Tanaka; Shingo Irikoma; Sotaro Kokubo

http://dx.doi.org/10.1590/S0034-70942013000300002 Braz J Anesthesiol, vol.63, n3, p.245-248, 2013
PDF Português
PDF English
Downloads: 0
Views: 969

Resumo

JUSTIFICATIVA E OBJETIVOS: A palpação foi demonstrada não ser muito precisa para identificar espaços interespinhosos lombares em anestesia neuroaxial. O objetivo deste estudo foi avaliar a precisão para determinar os espaços interespinhosos lombares pela palpação por anestesiologistas com o uso de radiografias pós-operatórias em pacientes obstétricas. MÉTODOS: Revisamos os registros anestésicos e as radiografias abdominais pós-operatórias de cesarianas. Inserimos o cateter epidural para analgesia pós-operatória com dose única. Incluímos casos de anestesia combinada raqui-peridural e comparamos o nível interespinhoso registrado pelo anestesiologista e o nível de inserção do cateter peridural confirmado pela radiografia abdominal de cada caso. Também avaliamos os fatores (idade, peso, altura, Índice de Massa Corporal, idade gestacional e tipo de cirurgia [programada/emergência]) que levaram à identificação errônea do nível interespinhoso. RESULTADOS: Foram avaliadas 835 cesarianas de 967 feitas. Os níveis das punções documentados pelos anestesiologistas estavam de acordo com os níveis reais de inserção dos cateteres em 563 casos (67%). Quando os anestesiologistas objetivaram identificar o nível L2-3, descobrimos que a inserção do cateter foi em L1-2 em cinco casos (4,9%), dos quais nenhum apresentou qualquer déficit neurológico pós-operatório. Nenhuma das variáveis avaliadas estava significativamente associada à identificação errônea do nível interespinhoso pelos anestesiologistas. CONCLUSÃO: Houve uma discrepância entre o nível estimado pela palpação dos anestesiologistas e o nível real de inserção do cateter mostrado nas radiografias. Parece ser mais seguro escolher o nível interespinhoso L3-4, ou mais baixo, em raquianestesia.

Palavras-chave

ANESTESIA, Obstétrica, CIRURGIA, Cesárea, ANALGESIA, Parto, Palpação, Radiografia

Abstract

BACKGROUND AND OBJECTIVES: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using post-operative X-rays in obstetric patients. METHODS: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confirmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentification of interspinous level. RESULTS: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological deficits. No variables evaluated were significantly associated with misidentification of interspinous level by the anesthesiologists. CONCLUSIONS: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.

Keywords

Anesthesia, Obstetrical, Cesarean section, Analgesia, Epidural, Palpation, Radiography

Referências

Reynolds F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia. 2001;56:238-247.

Parry H. Spinal cord damage. Anaesthesia. 2001;56.

Collier CB, Gatt SP. More reports of spinal cord damage by spinal needles. Anaesth Intensive Care. 2002;30.

Levins FA. Accuracy of placement of extradural needles in the L3-4 interspace: comparison of two methods of identifying L4. Br J Anaesth. 1991;66:381-382.

Van Gessel EF, Foster A, Gamulin Z. Continuous spinal anesthesia: where do spinal catheter go?. Anesth Analg. 1993;76:1004-1007.

Broadbent CR, Maxwell WB, Ferrie R, Wilson DJ, Gawne-Cain M, Russell R. Ability of anaesthetists to identify a marked lumbar interspace. Anaestehsia. 2000;55:1122-1126.

Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57:277-280.

Whitty R, Moore M, Macarthur A. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg. 2008;106:538-540.

Schlotterbeck H, Schaeffer R, Dow WA, Touret Y, Bailey S, Diemunsch P. Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia. Br J Anaesth. 2008;100:230-234.

Lee AJ, Ranasinghe JS, Chehade JM, Arheart K, Saltzman BS, Penning DH, Birnbach DJ. Ultrasound assessment of the vertebral level of the intercristal line in pregnancy. Anesth Analg. 2011;113:559-564.

Thomson A. Fifth annual report of the committee of collective investigation of Anatomical Society of Great Britain and Ireland for the Year 1893-1894. J Anat Physiol. ;1894(29):35-60.

Soleiman J, Dmaerel P, Rocher S, Marchal G. Magnetic resonance imaging study of the level of termination of the conus medullaris and the thecal sac: influence of age and gender. Spine. 2005;30:1875-1880.

Kim JT, Bahk JH, Sunf J. Influence of age and sex on the position of the conus medullaris and Tuffier's line in adults. Anesthesiology. 2003;99:1359-1363.

Faitot V, Ourchane R, Dahmani S, Magheru M, Nebout S, Gomas F, Katz A, Salomon L, Keita-Meyer H. An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients. Int J Obstet Anesth. 2011;20:124-127.

5dd4222d0e8825a30ac63493 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections