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Sensory assessment of epidural block for Caesarean section: a systematic comparison of pinprick, cold and touch sensation

Published online by Cambridge University Press:  01 March 2006

M. Camorcia  and
G. Capogna
M. Camorcia
Affiliation:
Città di Roma Hospital, Department of Anaesthesia, Roma, Italy
G. Capogna
Affiliation:
Città di Roma Hospital, Department of Anaesthesia, Roma, Italy
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Extract

Summary

Background and objective: Comparisons between the profile of regional blocks are difficult to make because different methods of testing are used among the studies. The aims of this prospective study were to describe the profile of epidural block by using a scoring system to evaluate the density of the block as assessed by the loss to pinprick, cold and touch sensation; to evaluate the extent of differential block and to determine whether there is any relationship between these three modalities of testing. Methods: We studied 85 parturients undergoing elective Caesarean delivery with epidural anaesthesia with pH adjusted lidocaine 2% with epinephrine 1:400.000 and sufentanil 10 μg. Assessment of sensory block was done in each dermatomal level bilaterally for loss to pinprick, cold and light touch sensation and the density of the block was evaluated on an ordinal scale every 5 min for 20 min and thereafter at 30 and 40 min. Results: We observed a two dermatomes differential block between the complete loss of cold sensation being cephalad and the complete loss of both pinprick and light touch sensation being caudal. We established a significant correlation between the scores used to assess the density of the block in the three different modalities by considering the pinprick score as reference (Spearman's rank correlation is 0.94, P < 0.001 for pinprick vs. cold, 0.97, P < 0.001 for pinprick vs. light touch). Conclusions: By scoring the density of the block on an ordinal scale, knowing the level of the block to pinprick allows one to predict the level of the block to touch and vice versa.

Keywords

ANAESTHESIA, EPIDURAL, sensory blockPAIN MEASUREMENTCAESAREAN SECTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 611 - 617
Copyright
© 2006 European Society of Anaesthesiology

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References

Greene NM. Area of differential block in spinal anaesthesia with hyperbaric tetracaine. Anesthesiology 1958; 19: 45–50.Google Scholar
Rocco AG, Raymond SA, Murray E, Dhingra U, Freiberger D. Differential spread of blockade of touch, cold, and pinprick during spinal anesthesia. Anesth Analg 1985; 64: 917–923.Google Scholar
Brull SJ, Greene NM. Tome courses of zone of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 1989; 69: 342–347.Google Scholar
White JL, Stevens RA, Kao TC. Differential sensory block: spinal vs. epidural with lidocaine. Can J Anaesth 1998; 45: 1049–1053.Google Scholar
Brull SJ, Greene NM. Zones of differential sensory block during extradural anaesthesia. Br J Anaesth 1991; 66: 651–655.Google Scholar
Stevens EA, Bray JG, Artuso JD, Kao TC, Spitzer L. Differential epidural block. Reg Anesth 1992; 17: 22–25.Google Scholar
Russell IF. Levels of anaesthesia and intraoperative pain at cesarean section under regional block. Intern J Obstet Anesth 1995; 4: 71–77.Google Scholar
Russell IF. A comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section. Int J Obstet Anesth 2004; 13: 146–152.Google Scholar
Liu SS, Ware PD. Differential sensory block after spinal bupivacaine in volunteers. Anesth Analg 1997; 84: 115–119.Google Scholar
White JL, Stevens RA, Beardsley D, Teague PJ, Kao TC. Differential epidural block. Does the choice of local anesthetic matter? Reg Anesth 1994; 19: 335–338.Google Scholar
Chamberlain DP, Chamberlain BDL. Changes in skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–143.Google Scholar
Buttner J, Klose R. Alkalinization of mepivacaine for axillary plexus anesthesia using a catheter. Reg Anaesth 1991; 14: 17–24.Google Scholar
Yentis S. Height of confusion: assessing regional blocks before caesarean section. Int J Obstet Anesth 2006; 15: 2–6.Google Scholar
Dalal P, Reynolds F, Gertenbach C et al. Assessing bupivacaine 10 mg/fentanyl 20 μg as an effective test dose. Int J Obstet Anesth 2003; 12: 250–255.Google Scholar
Sakura S, Sumi M, Yamada Y, Sayto Y, Kosaka Y. Quantitative and selective assessment of sensory block during lumbar epidural anaesthesia with 1% or 2% lidocaine. Br J Anaesth 1998; 81: 718–722.Google Scholar
Liu SS, Paul WD. Differential sensory block after spinal bupivacaine in volunteers. Anesth Analg 1997; 84: 115–119.Google Scholar
Parlow JL, Money P, Chan PSL, Raymond J, Milne B. Addition of opioids alters the density and spread of intrathecal local anesthetics? An in vitro study. Can J Anesth 1999; 46: 66–70.Google Scholar
Snedecor GW, Cochran WG. Statistical Methods, 7th edn. Iowa: The Iowa State University Press, 1987.
Hogan QH, Brost R, Kulier A et al. Magnetic resonance imaging of cerebrospinal fluid volume and the influence of body habitus and abdominal pressure. Anesthesiology 1996; 68: 1341–1349.Google Scholar
Hogan QH. Size of human lower thoracic and lumbosacral nerve roots. Anesthesiology 1996; 85: 37–42.Google Scholar