ABSTRACTS Abstracts and Highlight Papers of the 37th Annual European Society of Regional Anaesthesia & Pain Therapy (ESRA) 09/12/2018 on 1ojZViL9JnKxduCRhL/CcUAdyL6WwH5REYdVcwxqSc9xlxx/plvdjx0D6qkdcm/unXYqc/pwzsZMkY20jLisd3HCPQMoaMFxd03QOXvy15geUE+CR4J9Wp+ug9E5C+r4spJuQLeaJ8i4wLCpNFrgQgvjevOlNs34 by https://journals.lww.com/rapm from Downloaded Congress 2018: E-Poster Viewing Abstracts Downloaded Background and Aims: Deviation of the spinal needle leads to technical dif- from ESRA8-0027 ficulties and can cause neurological complications. The aims of this study are, https://journals.lww.com/rapm E-POSTER VIEWING first, to verify in clinical conditions the results from in vitro studies that the de- viation of the cutting type spinal needle depends on the mutual position of the CENTRAL NERVE BLOCKS bevels (its own and that of the introducer); and second, to compare the incidence of paresthesia with two accesses - median or paramedian. ≥ COMPARING RESISTANCE TO WATER FLOW BETWEEN Methods: 210 patients, aged 18 years, presented for elective surgery were in- TWO SPINAL NEEDLES cluded in a prospective randomised study. Spinal anesthesia in all patients was by performed in a lateral position with 88 mm 25G Quincke with 38 mm 20G in- 1ojZViL9JnKxduCRhL/CcUAdyL6WwH5REYdVcwxqSc9xlxx/plvdjx0D6qkdcm/unXYqc/pwzsZMkY20jLisd3HCPQMoaMFxd03QOXvy15geUE+CR4J9Wp+ug9E5C+r4spJuQLeaJ8i4wLCpNFrgQgvjevOlNs34 Al-Ani T. Queen Elizabeth University Hospital, Anaesthesia, Glasgow, United Kingdom. troducer at L2-3 or L3-4. Paresthesia and the number of attempts have been doc- Background and Aims: This study compares resistance to water flow be- umented. Patient Randomization is a web-based Mersenne Twister algorithm at  tween the newly introduced Pajunk Sprotte® NRFit 25G 90mm spinal needle a 1:1 allocation.  and our department previously used Vygon Whitacre 25G 90mm spinal needle. Results: A total of 13 cases (6.19%) were reported. The distribution with the Methods: Fifty-five ward nurses who have never used these needles before were parallel and opposite position of the bevels is: 6 cases (5.71%) and 7 cases recruited to use both needles in a simulated practice. Each needle was primed with (6.67%) respectively. In median access, patients without paresthesia had an av- water then attached to 5 ml syringe containing 2 ml water. Using the same hand, each erage of 1.21 attempts, and those with paresthesia - 2 attempts. Patients with nurse was asked to aspirate 1 ml from a glass filled with 10 ml water and then injects paramedian access were 1.67 and 2.25, respectively. Both differences were 3 ml under the water in the same glass. Unlimited attempts were permitted until they statistically significant, p < 0.0001. were able to determine if there is a difference in resistance between the two needles Conclusions: When performing spinal anesthesia, the mutual position of the or not. The following data were recorded: 1) The needle with the lowest resistance to two bevels, in parallel or opposite, does not lead to clinically significant devia- aspiration and injection 2) The number of aspiration and injection attempts. Partici- tion of the needle and does not affect the incidence of paresthesia. The incidence pants were not aware which needle is the newly introduced spinal needle. of paresthesia in spinal anesthesia does not depend on the type of access (me- Results: The majority of the participants felt that there is less resistance to as- dian or paramedian). pirate and inject when using the Vygon Whitacre compared with the Pajunk Sprotte NRFit needle (Figure 1). ESRA8-0106 E-POSTER VIEWING CENTRAL NERVE BLOCKS MOTOR-SPARING SPINAL ANESTHESIA TO ALLOW ACTIVE BALANCING DURING TOTAL KNEE ARTHROPLASTY Atchabahian A.1, Marks R.1, Cuff G.1, Cuevas R.1, Meere P.2 1NYU School of Medicine, Anesthesiology- Perioperative Care and Pain Medicine, New York, NY, USA, 2NYU School of Medicine, Orthopaedic Surgery, New York, NY, USA. Background and Aims: Successful total knee replacement (TKA) is depen- dent on balancing peak load at the medial and lateral tibiofemoral joint inter- faces. This can be achieved using a sterile sensor system intra-operatively. On the request of one surgeon at our institution, we explored the feasibility and The majority of participants were able to determine the difference in resis- safety of spinal anesthesia with limited motor blockade. tance in one attempt (72% of participants for aspiration and 74% for injection). Methods: 25 patients were enrolled in an IRB-approved non-randomized pilot The maximum number of attempts was three. study. For spinal anesthesia, a solution consisting of 1 mL of 5 mg/mL iso- Conclusions: Practitioners who have recently switched to the use of Pajunk baric bupivacaine with 1.5 mL sterile saline solution containing 7.5 mcg of Sprotte® NRFit 25G  90mm from Vygon Whitacre 25G  90mm spinal nee- sufentanil was administered. During surgery, after components were dle need to be aware of the higher resistance to flow on aspiration and injection. cemented, patients were awakened and asked to move their leg in order to on measure pressure balance. If an imbalance was noted, the surgeon would 09/12/2018 ESRA8-0201 make adjustments intraoperatively. Results: During the intraoperative wake-up test, 15 patients successfully flexed E-POSTER VIEWING and extended at the knee on command, while 10 were too weak for meaningful testing. As we reduced the local anesthetic volume to 0.8 mL in patients shorter CENTRAL NERVE BLOCKS than 160 cm, that issue was eliminated. One patient had neutral recollection of the test on follow up. No patient had pain or other side effect. THE DIRECTION OF THE BEVELS OF THE INTRODUCER Conclusions: A spinal anesthetic using sufentanil in combination with low- AND THE CUTTING SPINAL NEEDLE DOES NOTAFFECT THE dose local anesthetic appears feasible and safe to provide surgical anesthe- FREQUENCY OF PARESTHESIA - A PROSPECTIVE sia for TKA. By performing a motor-sparing spinal anesthetic with an intra- RANDOMIZED STUDY operative wake up test, we can allow surgeons to test active pressure balance Petrov V.1, Arabadzhieva D.1, Radev V.2 1UMBAL Kaneff Ruse, Department of to improve the accuracy of the pressure balancing technique. A randomized Anaesthesia and Intensive care, Ruse, Bulgaria, 2UMBAL Georgi Stranski - study is in preparation to determine whether long-term surgical result is Pleven, Clinic of Anesthesia and Intensive care, Pleven, Bulgaria. improved. Regional Anesthesia and Pain Medicine • Volume 43, Number 7, Supplement 1, October 2018 e97 Copyright © 2018 American Society of Regional Anesthesia and Pain Medicine. Unauthorized reproduction of this article is prohibited. ESRA Abstracts Regional Anesthesia and Pain Medicine • Volume 43, Number 7, Supplement 1, October 2018 ESRA8-0028 ESRA8-0503 E-POSTER VIEWING E-POSTER VIEWING CENTRAL NERVE BLOCKS CENTRAL NERVE BLOCKS A CLINICAL EXPERIENCE OF TITRATED DOSE OF RETROSPECTIVE STUDY OF 318 CONTINUOUS SPINAL ROPIVACAINE 0,75% IN UROLOGIC DAY CASE SURGERY CATHETERS OVER A 9 YEAR PERIOD IN A SINGLE Tsakiliotis S., Chasapidis V., Kakarougas A., Tsolakidou K., Mitsokapas A., TERTIARY INSTITUTION Rud I. General Hospital Papageorgiou, Anaesthesiology, Thessaloniki, Greece. Au Yong P.S. Singapore General Hospital, Department of Anaesthesia and In- Background and Aims: The ideal spinal anaesthetic for ambulatory settings tensive Care, Singapore, Singapore. has quick onset, short duration and minimal side effects. Perceiving delayed dis- Background and Aims: Continuous spinal anesthesia (CSA) is an under- charge, undesirable side effects, have limited the acceptance of day case surgery. utilized anesthetic technique. Our objectives were to evaluate the use of CSA We employ spinal anaesthesia for over 50% of short acting urinary procedures. in our institution, its efficacy, ease to use and safety over the nine-year period. We surveyed our titrated low dose spinal for day case urological patients: the Methods: This was a retrospective analysis conducted in a tertiary center. Records dose, time to recovery and any immediate side effects. of all patients who underwent surgery and received CSA between December 2008 Methods: This service evaluation does not require ethical approval. After in- and July 2017 were reviewed. Their demographic profiles, type and duration of formed consent 53 elderly patients ASA II, III were included. surgery were analyzed. The outcomes measured were the success of CSA, tech- We performed spinal anaesthesia with ropivacaine 0,75% in single dose nical evaluation and difficulties encountered, intraoperative hemodynamic, us- L3 – L4 space in different doses: 1,6 ml for time surgery<30 min. and 1,8 ml age of vasopressors, and any reported complications. for time surgery<60 min. Also we added 0,3 dextrose 35% ( hyperbaric solu- Results: 318 patients (94%) successfully underwent surgery using CSA. 20 cases tion) for the rapid onset and 0,3 ml fentanyl for the improvement of the quality failed to complete the operation under CSA thus requiring conversion to general of analgesia. After the administration we put the patient in Trendelenburg posi- anaesthesia. Patients who have had an initial intrathecal local anesthetic (LA) vol- tion and checked the level of sensory block every 30 sec. After the desirable ume of 1.5 ml or more were 2.78 (OR 95% CI 1.70-4.57) times more likely to level (in most cases T8) we put the patient in zero position. havehypotensionascomparedtothosewhohadlessthan1.5ml(p<0.001). Results: All patients had sensory block without motor block. The likelihood was higher in the high-risk group, with odds ratio, OR of 3.60 There were not any disturbances in hemodynamic variables and there was (95% CI 2.00 – 6.48; p<0.001). There were no reported post-dural puncture head- not a need for additional drugs, like sedative or inotropic. ache, neurological sequelae or infection. The discharge of patients from the recovery room was very rapid. Conclusions: CSA is a useful technique for various types of surgeries with Conclusions: It is important to improve the quality of work using the high success rate.