METHOD OF COMBINED SPINAL-EPIDURAL ANESTHESIA WITH THE EXPANSION OF THE EPIDURAL SPACE Russian patent published in 2023 - IPC A61M19/00 A61M25/01 A61K31/16 A61K33/14 A61P23/02 

FIELD: medicine; anesthesiology and surgery.

SUBSTANCE: invention can be used for combined spinal-epidural anesthesia with expansion of the epidural space in obese patients. With the help of an ultrasound navigator sensor, an interspinous gap suitable for puncture is determined at the level of III–IV lumbar vertebrae. Local anesthesia of the skin and subcutaneous adipose tissue with 2% lidocaine solution is performed on the selected area. The epidural space is punctured with a Tuochy 18 G epidural needle. The epidural space is identified by the "loss of resistance" method. Using a Quincke 27 G needle, the subarachnoid space is punctured; upon receipt in the pavilion of the needle of a drop of a transparent colorless cerebrospinal fluid, a 0.5% solution of the local anesthetic bupivacaine is injected into the subarachnoid space. To calculate the dosages of a local anesthetic, the body mass index (BMI) is calculated using the formula:

With a BMI value of 30–35 kg/m² the dose of bupivacaine is 2.5 ml (12.5 mg), and with a BMI of more than 35 kg/m² the dose of bupivacaine is 2 ml (10 mg). After the administration of bupivacaine, the Quinke 27 G needle is removed and a 20 G epidural catheter is inserted into the epidural space 3 cm in the cranial direction. An aspiration test is performed, a sterile bandage is applied to the skin puncture site, the catheter is fixed to the skin of the back with a sticker, and isotonic sodium chloride is injected through it. With a BMI of 30–34 kg/m², the volume of sodium chloride is 16 ml, with a BMI of 35–40 kg/m² the volume of sodium chloride is 13 ml, with a BMI of more than 40 kg/m² the volume of sodium chloride is 10 ml. Then the patient is laid on his back.

EFFECT: method reduces the risk of complications from the cardiovascular and respiratory systems during regional anesthesia in obese patients by taking into account the patient's individual anthropometric data.

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