Clinical trial of a method for conﬁrming the effects of spinal anesthesia in patients with spinal cord injury

J Anesth, 2012 · DOI: 10.1007/s00540-012-1429-z · Published: June 19, 2012

Spinal Cord Injury Anesthesiology Research Methodology & Design

Simple Explanation

This study investigated whether spinal anesthesia's effect could be confirmed in spinal cord injury (SCI) patients by observing the disappearance of lower extremity reflexes and spasticity, since traditional methods like pinprick tests are unreliable in these patients. The researchers examined 40 patients with chronic cervical SCI, noting the presence of Babinski sign, patellar tendon reflex, and spasticity before and after administering spinal anesthesia. The study found that the disappearance of the Babinski sign and patellar tendon reflex, along with the loss of spasticity, could effectively confirm the effect of spinal anesthesia in most patients with complete cervical SCI.

Study Duration

April 2010 and August 2011

Participants

40 patients with chronic, clinically complete cervical SCI

Evidence Level

Case series

Key Findings

1
The effect of SA in 39 patients (97.5 %) was conﬁrmed by demonstrating the absence of both the Babinski sign and patellar tendon reﬂex and loss of spasticity after SA.
2
The neurological ﬁndings on post-operative day 1 were consistent with those observed prior to anesthesia in all patients.
3
Loss of the Babinski sign, patellar tendon reﬂex, and spasticity might be useful for checking the effect of SA in cervical SCI patients.

Research Summary

This case series study prospectively examined whether the effect of spinal anesthesia (SA) could be checked in patients with spinal cord injury (SCI) based on the disappearance of lower extremity reﬂexes and spasticity. The study found that the effect of SA could be conﬁrmed by the disappearance of the Babinski sign and patellar tendon reﬂex and loss of spasticity in most patients with complete cervical SCI. The authors concluded that loss of the Babinski sign, patellar tendon reﬂex, and spasticity might be useful for checking the effect of SA in cervical SCI patients.

Practical Implications

Clinical Practice

Monitoring the Babinski sign, patellar tendon reflex, and spasticity can be a useful method for confirming the effectiveness of spinal anesthesia in patients with cervical SCI.

Anesthetic Management

The disappearance of PTR/BS and spasticity can guide the re-administration of spinal anesthesia to ensure adequate block.

Surgical Outcomes

Ensuring the disappearance of PTR/BS and spasticity before surgery may help prevent autonomic dysreflexia and spasticity-related complications during surgical procedures in SCI patients.

Study Limitations

1
Determination of the level of the block is difﬁcult.
2
The study population comprised patients with chronic, clinically complete cervical SCI.
3
Some patients exhibited negative PTR and BS even before SA.

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