|Ahead of print publication
Alternative use of intravenous set: A simple and cost-Effective technique to assess sensory blockade in spinal anesthesia
Gauri Raman Gangakhedkar, Yogalakshmi Palani
Department of Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
|Date of Submission||11-Jun-2020|
|Date of Decision||13-Aug-2020|
|Date of Acceptance||21-Sep-2020|
Gauri Raman Gangakhedkar,
13/14, Chandangad Apartments, Next to Rahul Nagar, Near Karve Putala, Kothrud, Pune - 411 038, Maharashtra
Source of Support: None, Conflict of Interest: None
The use of pinprick for assessment of the level of sensory blockade after spinal anesthesia is a time-tested modality. In order to overcome the shortcomings of pinprick while keeping in mind the economic restraints in a government-aided tertiary care institute, we have devised an alternative technique using the available resources. This article aims to highlight this technique and promotes the use of the same in other institutions.
Keywords: Alternative, sensory block, spinal anesthesia, test
|How to cite this URL:|
Gangakhedkar GR, Palani Y. Alternative use of intravenous set: A simple and cost-Effective technique to assess sensory blockade in spinal anesthesia. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Apr 12]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=310593
Assessment of sensory level of spinal block is integral in ensuring analgesia and muscle relaxation, thus an optimal field for surgery. Of the fibers that carry sensory stimuli, C- and A-delta carrying cold and pinprick sensation are used more frequently to test the level of sensory blockade as compared to A-beta representing mechanical stimuli such as touch and pressure.
Pinprick, using a needle that does not pierce the skin, is a favoured modality of assessment, on account of, the reliability of the test, ability to replicate the result and reduced inter-observer variance, pinprick. The disadvantages of pinprick, however, remain pain to patients, skin breakage from overzealous attempts by novices, and the most dreaded of them, accidental pinprick injuries to the administering doctor.
In an attempt to make testing safer and easier for the anesthesiologists in our institute, we have devised a modification of the locally available intravenous sets. The plastic tip of the set, which is used to prick the intravenous fluid bags, is cut off and used to assess the level of sensory blockade [Figure 1]. It has the obvious advantage of not breaking the skin even in the hands of the most inexperienced operator and thus eliminates the risk of pinprick injuries. Furthermore, it can potentially be used to test both light touch and pressure as desired. Although the inexpensive contrivance does not break the skin and can therefore be reused after sterilization with chlorhexidine and alcohol, we recommend that it be changed after use on 5–10 patients, to ensure pointed tips, thus rendering reliable results.
|Figure 1: (a) Intravenous set from which the tip was cut off. (b) The tip which has been cut off|
Click here to view
The standardized and validated commercially available devices such as neuro-tip and neuro-pen, seeking to eliminate the shortcomings of testing for touch and pinprick with cotton wisps and needles, are expensive. This limits their use in public health-care setups in developing countries. Fashioning a testing device from intravenous sets available on schedule, in a government hospital such as ours, reduces this added expenditure for the economically challenged population that seeks health care here. In addition, Kocarev et al. found no advantage or added reliability in using these devices over cost-effective techniques to test light touch or pinprick, thus supporting our choice to opt for an alternative testing modality.
While the use of this plastic tip has not yet been validated, it proposes to be a safe, reliable, and inexpensive albeit unconventional method to assess sensory blockade after spinal anesthesia and reflects our current institutional practice.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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