Effect of Different Methods of Skin Infiltration of Local Anesthetics on Pain during Spinal Anesthesia Induction

Abstract

Background: Spinal anesthesia needs needle insertion through the skin into the subarachnoid space. In most patients, this insertion causes pain which leads to discomfort, stress, unintended moving and finally, failure in spinal block. Heretofore, different methods have been evaluated to decrease the pain during spinal anesthesia. This study aimed to compare the effect of different methods of skin infiltration of local anesthetics on pain during spinal needle insertion. Methods: In a clinical trial study, 172 patients scheduled to undergo spinal anesthesia were randomly allocated into 4 equal groups: group 1 received intratecal injection without local anesthetic (control); group 2 received interatecal injection with local anesthesia of 1 cc lidocain 1% (skin wheal); group 3 received interatecal with local anesthesia of 2 cc lidocain 1% (subcutaneous); and group 4 received interatecal with local anesthesia with 3 cc lidocain 1% (subcutaneous and deep). Assessment of pain intensity during the spinal anesthesia induction using visual analog scale (VAS) was done. Findings: Mean pain intensity right after skin infiltaration in was not statistically different between the groups (P = 0.94). Mean pain intensity during the spinal anesthesia induction in was no statistically different between them, too (P = 0.54). But, the frequency of satisfaction was higher in those underwent skin wheal and subcutaneous methods than others. Conclusion: Skin infiltration in spinal anesthesia, if done appropriately, can improve the anesthesia procedure and patient satisfaction. Local anesthetic infiltration with skin wheal and subcutaneous methods improves the patients' satisfaction.

Keywords

• Spinal anesthesia
• Skin infiltration
• Local anesthesia