title: The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement During Spinal Anesthesia for Elective Cesarean Delivery.
abstract: It has been suggested that the dose requirement for spinal anesthesia (SA) is lower in obese patients for cesarean delivery (CD). In this prospective, observational, noninferiority study, we tested the hypothesis that obesity would not have a clinically important effect on vasopressor requirements or block height.
  
  
  
  Two groups of 25 parturients, group O (body mass index [BMI] >40 kg/m) and group N (BMI <32 kg/m) requiring elective CD were recruited. All patients received 10 mg intrathecal hyperbaric bupivacaine coadministered with 10 μg fentanyl. Dermatomal levels were assessed at 5 and 25 minutes after SA, and at completion of surgery, using light touch and cold sensation in response to ethyl chloride. The primary outcomes were phenylephrine requirement in the first 30 minutes after SA, and maximum block height, measured by the sensation of touch and cold. Secondary outcomes were total phenylephrine dose required, changes in hand grip strength, and peak flow rate.
  
  
  
  There were no significant between-group differences in median block height as assessed by touch at 5 or 25 minutes or by temperature at 5 minutes. At 25 minutes, there was a 2-dermatome difference in median block height for loss of temperature sensation between group O and group N (T2 vs T4, 95% confidence interval [CI] of the difference in medians 0-2 dermatomes). No blocks extended to cervical dermatomes. The median (range) phenylephrine dose for the first 30 minutes was 150 µg (0-900 µg), and 100 µg (0-1250 µg) in group N and group O, respectively. The 95% CI for the difference between the 2 median doses was -150 µg to 100 µg. There were no differences in median percentage reductions in peak flow rate or median hand grip strength after SA. Mean surgical time was longer in group O than in group N (49.1 vs 39.4 min, 95% CI difference 1.7-17.7 min). The mean time for recovery of touch sensation to T10 was longer in group O (152 vs 132 min, 95% CI difference 3.8-36.2 min). No analgesic supplementation was required.
  
  
  
  Only a minor increase in block height as assessed by temperature occurred in group O at 25 minutes. Vasopressor requirements during the first 30 minutes of SA were equivalent. Time for regression of SA block level was longer in the group O, which may be beneficial considering the longer surgical time. A dose of spinal bupivacaine 10 mg for single-shot SA should not be reduced in morbidly obese parturients.
authors.affiliation: From the *Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa; and †Department of Anaesthesia and Critical Care, University of Stellenbosch, Cape Town, South Africa.
authors.forename: T C
authors.initials: TC
authors.lastname: Ngaka
authors.forename: J F
authors.initials: JF
authors.lastname: Coetzee
authors.forename: R A
authors.initials: RA
authors.lastname: Dyer
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D002585:Cesarean Section / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D018737:Hand Strength; D006801:Humans; D009043:Motor Activity / Q000187:drug effects*; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017288:Pain Threshold / Q000187:drug effects; D036801:Parturition; D010656:Phenylephrine / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D020127:Recovery of Function; D012684:Sensory Thresholds / Q000187:drug effects*; D013019:South Africa; D013697:Thermosensing / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D005283:Fentanyl; D002045:Bupivacaine