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Intrathecal drug spread

2004; Elsevier BV; Volume: 93; Issue: 4 Linguagem: Inglês

10.1093/bja/aeh204

1471-6771

Grant Hocking, J.A.W. Wildsmith,

Spine and Intervertebral Disc Pathology

Many factors affect the intrathecal spread of injected local anaesthetics. However, the influence of most of them is small, unpredictable and beyond the clinician's control. The major factors are the baricity of the solution injected and the subsequent posture of the patient. The most predictable effects are produced by the slow injection (into a patient placed supine immediately thereafter) of a small volume of solution that contains glucose, a conclusion which is nearly a hundred years old, but is still not applied universally. Use of glucose concentrations somewhat lower (circa 1%) than are traditional (5–8%) will reduce the risk of excessive spread, but still ensure good quality and extent of block for most of the surgical procedures for which spinal anaesthesia is appropriate. Manipulation of the factors that affect spread may be used to produce different types of block, as long as the clinician has a clear understanding of what is involved.