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DEMONSTRATING THE EFFECT OF BARBOTAGE, SYRINGE SIZE AND POSITIONING ON THE SPREAD OF LOCAL ANAESTHETIC IN THE GLASS SPINE
ESRA Academy. Patel D. Sep 9, 2016; 138230
Topic: Local anaesthesia
Dave Patel
Dave Patel

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Abstract
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Background and Aims:

The glass spine was designed to simulate the vertebral column. It consists of a curved glass tube within which is a rubber injection port in the mid-lumbar region (Figure 1). Our aim was to demonstrate the effects of 1) barbotage, 2) syringe size and 3) Trendelenburg and reverse Trendelenburg positioning on the spread of a hyperbaric local anaesthetic solution in the glass spine.

Methods:

The glass spine was filled with normal saline which has a similar density to cerebrospinal fluid. 0.1ml of a red dye was added to 2.8ml of heavy Bupivicaine 0.5% before injecting the solution through the injection port using a 25G spinal needle. The solution was injected over 5 seconds with the spine upright. The spine was then laid supine and serial photographs taken at 20 second intervals post injection. 

Results:

The results demonstrated that barbotage does result in a quicker spread of anaesthetic solution as does the use of a 2ml syringe, the latter of which produced a more pronounced effect. 15 degree Trendelenburg positioning causes a more rapid, higher spread and end point. Reverse Trendelenburg positioning has the opposite effect and ultimately a lower end point in the lower thoracic segments.

Conclusions:

We advocate the use of a 5ml syringe and avoiding excessive barbotage when performing a spinal to achieve controlled spread of anaesthetic. The glass spine can be used as a useful visual learning tool for novice trainees to demonstrate the effects of a variety of factors on spread of local anaesthetics. 

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