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Anesth Analg 2002;94:476-477
© 2002 International Anesthesia Research Society

LETTERS TO THE EDITOR

Primary Score Predicting the Difficulty of Neuraxial Block

Mazen A. Karraz, MD

Anesthesiology and Critical Care Department, Louise Michel Hospital, Evry, France

To the editor:

Sprung et al. (1) had found that the landmarks on the patient’s back are the best predictor of the difficulty of the neuraxial block. Considering the influence that the Mallampati score (2) has had on airway management, I thought perhaps a similar type of score could be devised for neuraxial block. The following score is devised.

To define the grades of this score, the patient should be asked to sit down, bend the head, neck, and shoulders toward the chest as much as possible in attempt to protrude the spinous processes.

We then depended on vision and palpation to evaluate the grades as follows: Grade 1 = the spinous processes are visible; Grade 2 = the spinous processes are not seen but easily palpated; Grade 3 = the spinous processes are not seen and not palpated but the interval between them is palpated as a low land mark under the thumb; and Grade 4 = none of the previous cases.

And now my question to Sprung et al. (1): is not this score worthy of being a language between anaesthesiologists?

References

  1. Sprung J, Bourke DL, Grass J, et al. Predicting the difficult neuraxial block: a prospective study. Anesth Analg 1999; 89: 384–9.[Abstract/Free Full Text]
  2. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult intubation: a prospective study. Can Anesth Soc J 1985; 32: 429–34.[ISI][Medline]
 

Response

Denis L. Bourke, MD, and Juraj Sprung, MD, PhD

Anesthesiology Service (115), Baltimore Veterans Affairs Medical Center, Baltimore, Maryland Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

In Response:

We appreciate Dr. Karraz’s interest in our article (1) and we think he has hit upon an ingenious idea: a logical and more refined classification of spinal landmarks for neuraxial blockade. We would suggest an additional grading for obvious spinal deformity because we also found that to affect the ease of neuraxial blockade.

However, even a better grading system is of little value without some data to show us how to use the system to better anticipate problems and care for our patients. Although difficult neuraxial blocks may not have the dire consequences of a failed intubation, traumatic needle placements are associated with a higher incidence of potentially serious complications. With that in mind, we encourage Dr. Karraz to design a study for his grading system and publish the results.

References

  1. Sprung J, Bourke DL, Grass J, et al. Predicting the difficult neuraxial block: a prospective study. Anesth Analg 1999; 89: 384–9.




This Article
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Right arrow Articles by Karraz, M. A.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press