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The antero-posterior diameter of the lumbar dural sac does not predict sensory levels of spinal anesthesia for Cesarean delivery

[Le diamètre antéropostérieur du sac dural lombaire ne prédit pas l’étendue des niveaux sensitifs de la rachianesthésie pour la césarienne]

From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Cristian Arzola, Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Avenue, Room 781, Toronto, Ontario M5G 1X5, Canada. Phone: 416-586-4800, ext 2681; Fax: 416-586-8664; E-mail: carzolav{at}yahoo.com

Purpose: The lumbosacral cerebrospinal fluid (CSF) volume, as assessed by magnetic resonance imaging, is a major determinant of the intrathecal spread of local anesthetics. Ultrasound imaging of the lumbar spine allows measurement of dural sac dimensions, which we hypothesize can be used to estimate CSF volume. The purpose of this study was to investigate whether the dural sac antero-posterior diameter correlates with sensory levels of spinal anesthesia during elective Cesarean delivery (CD).

Methods: After Research Ethics Board approval and informed consent, a prospective observational study enrolled 41 patients scheduled for elective CD under spinal anesthesia. With ultrasound imaging (transverse approach, 2–5 MHz curved array probe), we measured the antero-posterior diameter of the lumbar dural sac (dural sac diameter, DSD). Spinal anesthesia was administered with 0.75% hyperbaric bupivacaine 1.6 mL, fentanyl 10 µg and morphine 100 µg, with the patient in the sitting position. Sensory block levels were assessed with ice and pinprick every five minutes until peak sensory levels (PSL) were attained. Spearman’s rank correlation was used to correlate DSD with PSL and time to attain PSL.

Results: There were no significant correlations between DSD and PSL assessed with ice (P = 0.474) or pinprick (P = 0.583). Similarly, there was no significant correlation between DSD and time to reach PSL, and between DSD and patient demographics.

Conclusion: The lumbar DSD, as determined by ultrasound, is not a predictor of spinal anesthesia spread. Further research is necessary to understand if ultrasound findings can be used to predict intrathecal spread of local anesthetics.

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