ANESTH ANALG 1990;70517-22
517
Hearing Loss After Spinal Anesthesia Is Related to Needle Size Johannes Fog, MD, Lars P. Wang, Carlo Mucchiano, MD
MD,
Albert Sundberg, PhD,
MD,
and
FOG 1, WANG LP, SUNDBERG A, MUCCHIANO C. Hearing loss after spinal anesthesia is related to needle sue. Anesth Analg 1990;70517-22.
statistically significant reduction in hearing level in the low-frequency range in patients in whom the 22-gauge needle was used. Hearing loss was unilateral at fiue
used. Hearing loss of 10 dB or more at any fre9uency was observed in 13 of 14 patients in the 22-gauge group and in 4 of 14 patients in the 26-gauge group. There was a
Key Words: ANESTHETIC TECHNIQUES, EAR, mAmm-spinal anesthesia.
Several reports have recently described hearing loss after spinal anesthesia (1-4), suggesting that minor hearing deficits frequently occur (1,4).This complication is in addition to another complication, postspinal headache. The incidence of postspinal headache is recognized as being directly related to the size of the spinal needle used (5,6). Whether hearing loss is a function of the size of the needle used is unknown. The aim of the present study was to determine the degree of vestibulocochlear dysfunction in patients having spinal anesthesia for transurethral resection of the prostate (TURP) and to determine if the incidence and degree of vestibulocochlear dysfunction are related to the size of the spinal needles used. We also wished to assess any possible correlation between hearing loss and postspinal headache.
Methods After Ethics Committee approval, informed consent was obtained from 28 patients scheduled for TURP under spinal anesthesia. Exclusion criteria included systemic disorders (apart from arteriosclerosis), a history of deafness, inspissated cerumen, and inability to cooperate during audiometry. Received from the Department of Anesthesia, Eksjii-Nrissjii Hospital, Eksjo, Sweden. Accepted for publicationJanuary2,1990. Address correspondenceto Dr.Sundberg, Department of Anesthesia, Eksjd-Nrissjo Hospital, S-575 28 Eksjo, Sweden. 01990 by the International Anesthesia Research society
SPINAL.
The audiologic evaluation consisted of pure tone audiometry using the ascending technique performed by experienced audiometrists. A Madsen OB 70 or OB 522 audiometer (Madsen Electronics, Herlev, Denmark) was used and the system calibrated according to IS0 389, 1975. Audiometry was performed in double-walled silent chambers. The patients were randomized to receive spinal anesthesia using either a 22-gauge or a 26-gauge spinal needle. On the morning of operation an audiogram was performed in each patient. Premedication followed with 25 mg of meperidine and 10 mg of the sedative dixyrazine (a phenothiazine derivative) given intramuscularly. After intravenous infusion of at least 500 mL of Ringer's lactate solution, spinal anesthesia was administered in the L3-4 interspace using 3.5 mL of 0.5% bupivacaine in 8% glucose. One dural puncture was allowed in each patient; if an additional dural puncture was necessary the patient was removed from the study. The bevel of the needle was inserted parallel to the longitudinal dural fibers. Systolic arterial blood pressure was measured by sphygmomanometry at 5-min intervals during the operation, and any untoward event was recorded. The level of analgesia was estimated by the pin-prick method after 20 min. All patients remained recumbent for the first 12 postoperative hours. On the second postoperative day a second audiogram was performed in each patient under the same conditions as the preoperative examination. The audiometrist
FOG ET AL.
ANESTH ANALL
518
1990;70:517-22
Table 1. Spinal Anesthesia With 22-Gauge Needle
Patient
Age (yr)
Height (cm)
Weight (kg)
1 2 3 4 5 6 7 8 9 10 11 12 13 14
64
165 175 181 178 168 168 172 165 172 172 180 173 173 171
54 86 72 85 60 78 80 70 75 65 96 71 76 88
Mean
2 SEM
74 64 69 79 78 64 67 62 64 80 51 60 67 67.4
2.2
~t_
172.4 2 1.3
75.4
2
Level of analgesia (thoracic segments) 6 7 10 9 7 6 7 5 11 4 6 5 8 7
3.0
7.0
Postoperative systolic Maximum decrease blood pressure in systolic blood Postoperative (mm Hg) pressure (mm Hg) headache
* 0.5
-
150 160 120 140 170 160 130 120 160 180 170 120 130 210
40 50 20 40 90 40 30 40 30 65 30 20 45 60
151 5 7
43 t 5
-
-
-
-
Table 2. Spinal Anesthesia With 26-Gauge Needle
Patient
Age (yr)
1 2 3 4 5
59 77 68 61 67 59 79 67 79 70 79 80 66 79
6
7 8 9
10 11 12 13 14
Mean
2 SEM
70.7
2
Level of analgesia Height (cm) Weight (kg) (thoracic segments) 167 176 181 163 183 176 171 183 176 181 170 176 187 178
22
176.3 2 1.8
69 70 78 63 80 90 75 84 78 77 67 72 75 85 75.9
2
Postoperative systolic Maximum decrease blood pressure in systolic blood Postoperative (mm Hg) pressure (mm Hg) headache
5 7 6 8 6 10 7 7 8 10 5 4 5 6
2.0
6.7
2
and the patient were unaware of the needle size used. On the second postoperative day each patient was also examined by an anesthesiologist to determine the presence or absence of postspinal headache or dysfunction of the third, fourth, sixth, seventh, or eighth cranial newes. All results are presented as mean ? SEM. In each pair of audiograms from each patient the change in hearing level was calculated at each frequency. The mean change in hearing level for right and left ears respectively for all patients in each of the two groups was calculated at each frequency. A ”worse side” was defined as the side on which hearing loss was greater. The results were analyzed for statistical significance using a t-test. Student’s f-test for indepen-
210 180 160 130 180 140 130 180 190 180 180 180 180 130 0.5
168 2 7
-
45 20 60 20 60 30 25 40 50 40 60 70 30 40 42
2
4
dent samples was used to establish the possible statistical significance of demographic and audiometric differences between the groups. P-values of
517
Hearing Loss After Spinal Anesthesia Is Related to Needle Size Johannes Fog, MD, Lars P. Wang, Carlo Mucchiano, MD
MD,
Albert Sundberg, PhD,
MD,
and
FOG 1, WANG LP, SUNDBERG A, MUCCHIANO C. Hearing loss after spinal anesthesia is related to needle sue. Anesth Analg 1990;70517-22.
statistically significant reduction in hearing level in the low-frequency range in patients in whom the 22-gauge needle was used. Hearing loss was unilateral at fiue
used. Hearing loss of 10 dB or more at any fre9uency was observed in 13 of 14 patients in the 22-gauge group and in 4 of 14 patients in the 26-gauge group. There was a
Key Words: ANESTHETIC TECHNIQUES, EAR, mAmm-spinal anesthesia.
Several reports have recently described hearing loss after spinal anesthesia (1-4), suggesting that minor hearing deficits frequently occur (1,4).This complication is in addition to another complication, postspinal headache. The incidence of postspinal headache is recognized as being directly related to the size of the spinal needle used (5,6). Whether hearing loss is a function of the size of the needle used is unknown. The aim of the present study was to determine the degree of vestibulocochlear dysfunction in patients having spinal anesthesia for transurethral resection of the prostate (TURP) and to determine if the incidence and degree of vestibulocochlear dysfunction are related to the size of the spinal needles used. We also wished to assess any possible correlation between hearing loss and postspinal headache.
Methods After Ethics Committee approval, informed consent was obtained from 28 patients scheduled for TURP under spinal anesthesia. Exclusion criteria included systemic disorders (apart from arteriosclerosis), a history of deafness, inspissated cerumen, and inability to cooperate during audiometry. Received from the Department of Anesthesia, Eksjii-Nrissjii Hospital, Eksjo, Sweden. Accepted for publicationJanuary2,1990. Address correspondenceto Dr.Sundberg, Department of Anesthesia, Eksjd-Nrissjo Hospital, S-575 28 Eksjo, Sweden. 01990 by the International Anesthesia Research society
SPINAL.
The audiologic evaluation consisted of pure tone audiometry using the ascending technique performed by experienced audiometrists. A Madsen OB 70 or OB 522 audiometer (Madsen Electronics, Herlev, Denmark) was used and the system calibrated according to IS0 389, 1975. Audiometry was performed in double-walled silent chambers. The patients were randomized to receive spinal anesthesia using either a 22-gauge or a 26-gauge spinal needle. On the morning of operation an audiogram was performed in each patient. Premedication followed with 25 mg of meperidine and 10 mg of the sedative dixyrazine (a phenothiazine derivative) given intramuscularly. After intravenous infusion of at least 500 mL of Ringer's lactate solution, spinal anesthesia was administered in the L3-4 interspace using 3.5 mL of 0.5% bupivacaine in 8% glucose. One dural puncture was allowed in each patient; if an additional dural puncture was necessary the patient was removed from the study. The bevel of the needle was inserted parallel to the longitudinal dural fibers. Systolic arterial blood pressure was measured by sphygmomanometry at 5-min intervals during the operation, and any untoward event was recorded. The level of analgesia was estimated by the pin-prick method after 20 min. All patients remained recumbent for the first 12 postoperative hours. On the second postoperative day a second audiogram was performed in each patient under the same conditions as the preoperative examination. The audiometrist
FOG ET AL.
ANESTH ANALL
518
1990;70:517-22
Table 1. Spinal Anesthesia With 22-Gauge Needle
Patient
Age (yr)
Height (cm)
Weight (kg)
1 2 3 4 5 6 7 8 9 10 11 12 13 14
64
165 175 181 178 168 168 172 165 172 172 180 173 173 171
54 86 72 85 60 78 80 70 75 65 96 71 76 88
Mean
2 SEM
74 64 69 79 78 64 67 62 64 80 51 60 67 67.4
2.2
~t_
172.4 2 1.3
75.4
2
Level of analgesia (thoracic segments) 6 7 10 9 7 6 7 5 11 4 6 5 8 7
3.0
7.0
Postoperative systolic Maximum decrease blood pressure in systolic blood Postoperative (mm Hg) pressure (mm Hg) headache
* 0.5
-
150 160 120 140 170 160 130 120 160 180 170 120 130 210
40 50 20 40 90 40 30 40 30 65 30 20 45 60
151 5 7
43 t 5
-
-
-
-
Table 2. Spinal Anesthesia With 26-Gauge Needle
Patient
Age (yr)
1 2 3 4 5
59 77 68 61 67 59 79 67 79 70 79 80 66 79
6
7 8 9
10 11 12 13 14
Mean
2 SEM
70.7
2
Level of analgesia Height (cm) Weight (kg) (thoracic segments) 167 176 181 163 183 176 171 183 176 181 170 176 187 178
22
176.3 2 1.8
69 70 78 63 80 90 75 84 78 77 67 72 75 85 75.9
2
Postoperative systolic Maximum decrease blood pressure in systolic blood Postoperative (mm Hg) pressure (mm Hg) headache
5 7 6 8 6 10 7 7 8 10 5 4 5 6
2.0
6.7
2
and the patient were unaware of the needle size used. On the second postoperative day each patient was also examined by an anesthesiologist to determine the presence or absence of postspinal headache or dysfunction of the third, fourth, sixth, seventh, or eighth cranial newes. All results are presented as mean ? SEM. In each pair of audiograms from each patient the change in hearing level was calculated at each frequency. The mean change in hearing level for right and left ears respectively for all patients in each of the two groups was calculated at each frequency. A ”worse side” was defined as the side on which hearing loss was greater. The results were analyzed for statistical significance using a t-test. Student’s f-test for indepen-
210 180 160 130 180 140 130 180 190 180 180 180 180 130 0.5
168 2 7
-
45 20 60 20 60 30 25 40 50 40 60 70 30 40 42
2
4
dent samples was used to establish the possible statistical significance of demographic and audiometric differences between the groups. P-values of
