A clinical prediction of skin to subarachnoid space depth in parturients undergoing caesarean delivery in a Nigerian population.

Few studies on the prediction of skin to subarachnoid space depth (SSD) in African parturients undergoing caesarean delivery are available. We undertook a prospective observational study of 402 parturients scheduled for elective caesarean delivery to determine simple and clinically applicable formulae for predicting skin to SSD. Additionally, the impact of patient characteristics and variables such as age, height, weight, body mass index (BMI), and body surface area on SSD was studied. We employed a Stepwise Multiple Linear Regression Model to predict SSD in normal weight, overweight, and obese parturients using previously described formulae and compared our derived SSDs to these previous formulae for concordance. (Craig, Abe, Stocker, Chong's modified, Prakash, Ma, Hazarika, Taman and Celik). Mean SSD was 6.62 ± 1.07 cm in the overall population. SSD in normal weight patients was (6.19 ± 0.92 cm), overweight (6.44 ± 0.92 cm) and obese (6.97 ± 1.17 cm). There was a correlation between SSD and BMI (p = 0.001). Formulae for predicting SSD in the overall population, normal weight, overweight and obese parturients were 4.34 + weight × 0.03, 4.43 + weight × 0.03, 4.54 + weight × 0.03 and 3.56 + weight × 0.03, respectively. We also found the Prakash formula to correlate best with our observed SSD. We concluded that SSD correlated well with weight in the overall parturient population and that Prakash's formula was the most accurate of the other previously described formulae in predicting SSD in this subset of African parturients.

What is already known on this subject? Various formulae exist for predicting skin to subarachnoid space depth in adult patients and parturients.What the results of this study add? New formulae for predicting skin to subarachnoid space in a subset of African parturients are described and only one of the previously described formulae was found to reliably predict depth of the subarachnoid space in this cohort.What the implications are of these findings for clinical practice and/or further research? Formulae for the determination of skin to subarachnoid space depth using weight alone can be predictive for normal, overweight and obese parturients. Knowledge of the predicted depth can help guide appropriate needle selection and minimise wastage, especially in resource poor countries.

Eight-hour versus 24-h urethral catheter removal following elective caesarean section for reducing significant bacteriuria: A randomized controlled trial.

BACKGROUND: There is no consensus on the preferred time to remove urethral catheter post caesarean section. AIM: To compare rate of significant bacteriuria and urinary retention following 8-h (study) and 24-h urethral catheter removal (control) post elective caesarean section. METHODS: A randomized controlled trial of eligible participants that underwent elective caesarean section under spinal anaesthesia between March 2019 and November 2019 was conducted. Participants (150 in each arm) were randomly assigned (1:1 ratio) to either 8-h or 24-h group. Primary outcome measures included rates of significant bacteriuria 48-h post-operatively and acute urine retention 6-h post urethral catheter removal. Analysis was by Intention-to-treat. (www.pactr.org:PACTR202105874744483). RESULTS: There were 150 participants randomized into each arm and data collection was complete. Significant bacteriuria was less in 8-h group (3% versus 6.0%; risk ratio (RR): 0.85 CI: 0.60 to 5.66; p = 0.274), though not significant. Acute urinary retention requiring repeat catheterisation was significantly higher in 8-h group (11(7.3%) versus 0(0.0%); RR: 0.07; CI: 0.87 to 0.97; p = 0.001). Mean time until first voiding was slightly higher in 8-h group (211.4 ± 14.3 min versus 190.0 ± 18.3 min; mean difference (MD): 21.36; CI: -24.36 to 67.08; p = 0.203); but patient in this group had a lower mean time until ambulation (770.0 ± 26.1 min versus 809 ± 26.2 min; MD: -38.8; CI: -111.6 to 34.0; p = 0.300). The 8-h group were significantly more satisfied (82/150 (54.7%) versus 54/150 (36.0%); p = 0.001). CONCLUSIONS: An 8-h group was associated with significant clinical satisfaction and acute urine retention compared to 24-h removal. The timing of urethral catheter removal did not affect rate of significant bacteriuria and other outcomes.

Effects of low-dose intravenous dexamethasone combined with caudal analgesia on post-herniotomy pain.

BACKGROUND: Caudal analgesia for postoperative pain relief in paediatric day-case surgery has been found to be of short duration, hence the need for addition of adjuncts to prolong the analgesia. OBJECTIVE: The objective of the study was to compare the analgesic effects of caudal block with or without low-dose intravenous dexamethasone in children undergoing day-case herniotomy. PATIENTS AND METHODS: This was a prospective randomised controlled study conducted in male patients, aged between 1 and 7 years scheduled for herniotomy. A total of 94 patients were randomised into two groups. Group A received intravenous 0.25 mg/kg dexamethasone in 5 ml solution, whereas Group B received equivalent volume of intravenous normal saline. All the patients had a caudal block. Post-operative pain was assessed and recorded in post-anaesthesia care unit (PACU) using objective pain scale. Time to first analgesia request (TFA), pain scores and complications were documented. Data were analysed using Statistical Package for the Social Sciences version 21.0. RESULTS: A total of 94 patients were analysed with a mean age of 3.30 ± 1.67 and 3.06 ± 1.50 years for Groups A and B, respectively. The TFA request was 654.18 ± 31.56 and 261.50 ± 10.82 min in Groups A and B, respectively, P = 0.0001. Postoperatively, in the PACU, there was statistically significant difference in pain score between the two groups at 0, 30, 60, 120, 180 and 240 min (P = 0.0001) all through. CONCLUSION: The use of low-dose intravenous dexamethasone (0.25 mg/kg) in combination with caudal block prolonged duration of analgesia, reduced pain scores and analgesic consumption postoperatively, in children undergoing day-case herniotomy.