ESTIMATION OF SKIN TO SUBARACHNOID SPACE DEPTH IN INDIAN POPULATION: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Skin to Subarachnoid Space Depth (SSD), Sub-arachnoid Block (SAB), Lumbar Puncture (LP)
Abstract
BACKGROUND: Subarachnoid block (SAB) is the most routinely practiced anesthesia technique for all patients undergoing lower abdominal and lower limb surgeries including pregnant females posted for cesarean sections. It is commonly done by an anatomical landmark-guided approach. Many factors such as Height, Weight, BMI, and BSA influence the successful tapping of CSF.
MATERIALS AND METHODS: After institutional ethical committee clearance and written informed consent, 300 adult ASA grade I/II patients of either sex scheduled for various procedures under spinal anesthesia were included in the study and were divided into 3 groups as Males (Group M), Females (Group F) and Pregnant Females (Group PF) of 100 each. The patient’s anthropometric details like Height and weight were recorded during routine pre-anesthetic evaluation. After connecting standard monitors, with the patient in sitting position, spinal anesthesia was given at L3-L4 intervertebral space by midline approach. The SSD was measured using a sterile marking pen. BMI, BSA and Predicted SSD were calculated using pre-existing formulae. All the data were entered into an Excel sheet and statistically analyzed.
RESULTS: The mean SSD in our population was 6.182±0.5603cm and the SSD of males, females, and pregnant females were 6.350±0.5186cm, 5.95±0.5245cm, and 6.24±0.5650 cm respectively.
CONCLUSION: The mean SSD was higher in males compared to nonpregnant females. The mean of actual SSD when compared with the mean of SSD calculated using pre-existing formulae using anthropometric measurements did not show any statistically significant correlation. However, we were able to derive a new formula to calculate SSD using anthropometric data obtained from our study population.
MATERIALS AND METHODS: After institutional ethical committee clearance and written informed consent, 300 adult ASA grade I/II patients of either sex scheduled for various procedures under spinal anesthesia were included in the study and were divided into 3 groups as Males (Group M), Females (Group F) and Pregnant Females (Group PF) of 100 each. The patient’s anthropometric details like Height and weight were recorded during routine pre-anesthetic evaluation. After connecting standard monitors, with the patient in sitting position, spinal anesthesia was given at L3-L4 intervertebral space by midline approach. The SSD was measured using a sterile marking pen. BMI, BSA and Predicted SSD were calculated using pre-existing formulae. All the data were entered into an Excel sheet and statistically analyzed.
RESULTS: The mean SSD in our population was 6.182±0.5603cm and the SSD of males, females, and pregnant females were 6.350±0.5186cm, 5.95±0.5245cm, and 6.24±0.5650 cm respectively.
CONCLUSION: The mean SSD was higher in males compared to nonpregnant females. The mean of actual SSD when compared with the mean of SSD calculated using pre-existing formulae using anthropometric measurements did not show any statistically significant correlation. However, we were able to derive a new formula to calculate SSD using anthropometric data obtained from our study population.
References
[1] Tyagi V, Jain V, Agarwal B, Jain M, Rastogi B, Srivastava S. A prospective observational study to compare the depth of subarachnoid space using anthropometric measurements, ultrasonographic measurements and actual depth by needle insertion. Ann Clin Lab Res 2019;7(1):284.
[2] Bier A. Experiments on cocainization of the spinal cord. English Periodical Surgery 1899;51(3):352.
[3] Wong JO, Chang CL. The distance from the skin to the epidural space in general population. Ma Zui Xue Za Zhi 1990;28(1):63-8.
[4] Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, et al. Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. JAMA 2002;288:2001-7.
[5] Prakash S, Mullick P, Kumar S, Singh R, Gogia AR. A prospective observational study of skin to subarachnoid space depth in the Indian population. Indian J Anaesth 2014;58:165-70.
[6] Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intensive Care 1993;21:309-10.
[7] Eknoyan G. Adolphequetelet (1796-1874) – The average man and indices of obesity. Nephrol Dial Transplant. 2008; 23:47-51
[8] Mosteller RD. Simplified calculation of body‑surface area. N Engl J Med 1987;317:1098.
[9] Taman HI, Farid AM, Abdelghaffar WM. Measuring skin to subarachnoid space depth in Egyptian population: A prospective cohort study. Anaesth Essays Res 2016;10(3):468.
[10] Hazarika R, Choudhary D, Nath S, Parua S. Estimation of skin to subarachnoid space depth: An observational study. JCDR 2016;10(10):6.
[11] Stocker DM, Bonsu B. A rule based on body weight for predicting the optimum depth of spinal needle insertion for lumbar puncture in children. Acad Emerg Med 2005;5:105‑6.
[12] Craig F, Stroobant J, Winrow A, Davies H. Depth of insertion of a lumbar puncture needle. Arch Dis Child 1997;77(5):450.
[13] Chong SY, Chong LA, Ariffin H. Accurate prediction of the needle depth required for successful lumbar puncture. Am J Emerg Med 2010;28:603‑6.
[14] Abe KK, Yamamoto LG, Itoman EM, Nakasone TA, Kanayama SK. Lumbar puncture needle length determination Am J Emerg Med 2005;23(6):742.
[15] Bonadio WA, Smith DS, Metrou M, Dewitz B. Estimating lumbar‑puncture depth in children. N Engl J Med 1988;319:952‑3.
[16] Sargin M, Hanedan B, Aydoğan E, Toprak H, Akin F, et al. Evaluation of factors that affect skin-to-subarachnoid space distance. J Health Sci 2017;7(1):23.
[2] Bier A. Experiments on cocainization of the spinal cord. English Periodical Surgery 1899;51(3):352.
[3] Wong JO, Chang CL. The distance from the skin to the epidural space in general population. Ma Zui Xue Za Zhi 1990;28(1):63-8.
[4] Howard SC, Gajjar AJ, Cheng C, Kritchevsky SB, Somes GW, Harrison PL, et al. Risk factors for traumatic and bloody lumbar puncture in children with acute lymphoblastic leukemia. JAMA 2002;288:2001-7.
[5] Prakash S, Mullick P, Kumar S, Singh R, Gogia AR. A prospective observational study of skin to subarachnoid space depth in the Indian population. Indian J Anaesth 2014;58:165-70.
[6] Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intensive Care 1993;21:309-10.
[7] Eknoyan G. Adolphequetelet (1796-1874) – The average man and indices of obesity. Nephrol Dial Transplant. 2008; 23:47-51
[8] Mosteller RD. Simplified calculation of body‑surface area. N Engl J Med 1987;317:1098.
[9] Taman HI, Farid AM, Abdelghaffar WM. Measuring skin to subarachnoid space depth in Egyptian population: A prospective cohort study. Anaesth Essays Res 2016;10(3):468.
[10] Hazarika R, Choudhary D, Nath S, Parua S. Estimation of skin to subarachnoid space depth: An observational study. JCDR 2016;10(10):6.
[11] Stocker DM, Bonsu B. A rule based on body weight for predicting the optimum depth of spinal needle insertion for lumbar puncture in children. Acad Emerg Med 2005;5:105‑6.
[12] Craig F, Stroobant J, Winrow A, Davies H. Depth of insertion of a lumbar puncture needle. Arch Dis Child 1997;77(5):450.
[13] Chong SY, Chong LA, Ariffin H. Accurate prediction of the needle depth required for successful lumbar puncture. Am J Emerg Med 2010;28:603‑6.
[14] Abe KK, Yamamoto LG, Itoman EM, Nakasone TA, Kanayama SK. Lumbar puncture needle length determination Am J Emerg Med 2005;23(6):742.
[15] Bonadio WA, Smith DS, Metrou M, Dewitz B. Estimating lumbar‑puncture depth in children. N Engl J Med 1988;319:952‑3.
[16] Sargin M, Hanedan B, Aydoğan E, Toprak H, Akin F, et al. Evaluation of factors that affect skin-to-subarachnoid space distance. J Health Sci 2017;7(1):23.
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Published
Jan 18, 2025
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Dr. Madhu K. P, Dr. Deepika A., Dr. Yathish S. K., & Dr. Suryanarayana. (2025). ESTIMATION OF SKIN TO SUBARACHNOID SPACE DEPTH IN INDIAN POPULATION: A PROSPECTIVE OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 232-239. https://doi.org/10.53555/bsdgxb51
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Author Biographies
Dr. Madhu K. P
Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
Dr. Deepika A.
Post Graduate, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
Dr. Yathish S. K.
Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
Dr. Suryanarayana
Senior Specialist, Department of Anesthesiology, District Hospital, Udupi, Karnataka, India.
How to Cite
Dr. Madhu K. P, Dr. Deepika A., Dr. Yathish S. K., & Dr. Suryanarayana. (2025). ESTIMATION OF SKIN TO SUBARACHNOID SPACE DEPTH IN INDIAN POPULATION: A PROSPECTIVE OBSERVATIONAL STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 232-239. https://doi.org/10.53555/bsdgxb51