Effect of Abdominal Girth and Vertebral Column Length on the Spread of Spinal Anesthesia with Fixed-dose Plain 0.5% Levobupivacaine

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Abstract Background: The spread of spinal anesthesia can be unpredictable and is influenced by various factors. A high spinal block increases the incidence of hemodynamic instability and duration of hospital stay, whereas a low level of block may result in inadequate surgical anesthesia. It has been hypothesized that body shape metrics in terms of abdominal girth (AG) and vertebral column length (VCL) influence the spread of local anesthetic within the subarachnoid space and the level of sensory block achieved. We explored the effects of AG, VCL, and their ratio on the level of sensory block achieved after the administration of a fixed dose of levobupivacaine. Methods: Fifty patients, ASA Grade Ι-ΙΙ, from 18 to 60 years of age scheduled for elective lower abdominal, pelvic, or lower limb surgery were enrolled in this observational study. Weight, height, body mass index (BMI), AG, and VCL were recorded preoperatively. Subarachnoid block was administered with 3 ml of 0.5% plain levobupivacaine in all patients using a standard 25G Quincke needle in lateral decubitus position through midline approach at the L3L4 intervertebral space. The correlation between the maximal sensory level of the block and physical parameters was analyzed using the Spearman rank correlation coefficient. Results: The parameters were statistically correlated with maximal sensory block by Spearman rank correlation coefficient ( r ) using linear regression analysis. The correlation of age ( r = 0.076 and P = 0.601), height ( r = −0.049 and P = 0.737), and VCL ( r = −0.046 and P = 0.753) of the patient to the maximum level of sensory block achieved was not statistically significant. Whereas, the weight ( r = 0.43 and P = 0.002), BMI ( r = 0.452 and P = 0.001), AG ( r = 0.662 and P ≤ 0.001), and the ratio VCL/AG 2 ( r = −0.673 and P ≤ 0.001) had statistically significant correlation with the level of sensory block achieved at 30 min after the administration of 3 ml of 0.5% plain levobupivacaine. Conclusion: VCL/AG 2 which simulated the ratio of long axis and the transaction area of abdomen may help anesthesiologists choose the proper local anesthetic dose for the subarachnoid block to achieve appropriate surgical anesthesia.

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