Oregon Health and Science University
This will be a prospective, observational, single-center study to evaluate the accuracy of sensory testing by blunt 16-gauge plastic cannula during the 15 minutes after spinal injection for predicting spinal failure. While previous studies assessed the minimal sensory level required for painless cesarean delivery at skin incision or delivery, no studies have assessed the accuracy of sensory testing at an earlier time point.
Primary Objective: 1\. Evaluate the accuracy of sensory testing with blunt plastic 16-gauge cannula during the 15 minutes after spinal injection for predicting spinal failure. Cephalad sensory dermatomal levels will be assessed at 1 (t1), 3 (t3), 5 (t5), 7 (t7), 9 (t9), 11 (t11), 13 (t13), and 15 (t15) minutes after intrathecal 1.6 ml 0.75% bupivacaine in 8.25% dextrose combined with 15 mcg fentanyl and 150 mcg morphine (study solution). Spinal failure, which is defined as inability to achieve a T4 level to pinprick by the 15-minute timepoint or intraoperative pain (VAS \> 0) requiring treatm…
Inclusion Criteria: * Patients undergoing cesarean delivery under spinal or combined spinal epidural anesthesia * BMI between 20 and 40 kg/m2 * Height between 5 feet 2 inches and 5 feet 10 inches. * English and non-English speaking patients, if interpretive services are available Exclusion Criteria: * Patient refusal * Contraindications to neuraxial anesthesia (coagulopathy, CNS pathology, infection at site of needle puncture) * Allergy to any study medications * Use of epidural anesthesia * Emergency (red) cesarean delivery * Conditions that impact dermatomal sensory testing including spin…
Patients will receive standard intrathecal medications for urgent and scheduled cesarean delivery at the study site. All study subjects will receive bupivacaine, fentanyl, and morphine.
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