Kahveci Mürsel, Uğur Levent
Anesthesiology and Reanimation, Amasya Training and Research Hospital, Amasya University, Amasya 05100, Turkey.
Department of Mechanical Engineering, Faculty of Engineering, Amasya University, Amasya 05100, Turkey.
J Clin Med. 2025 Sep 3;14(17):6236. doi: 10.3390/jcm14176236.
Spinal anesthesia is a widely used technique for pain control in surgical procedures, requiring effective drug distribution within the cerebrospinal fluid (CSF) for optimal outcomes. The distribution is influenced by injection parameters such as needle diameter and injection speed, which, if not optimized, can reduce efficacy or cause side effects. This study investigates how these parameters affect drug distribution in the CSF using computational fluid dynamics (CFD). An anatomically accurate three-dimensional model of the CSF space was created using MRI data. Simulations were performed using three needle tips (22 G, 25 G, 27 G) and different injection rates at the L4-L5 vertebral level. The model included physiological CSF oscillations from cardiac and respiratory cycles. Drug dispersion was analyzed in terms of spatial distribution and concentration changes over time. The findings obtained show that the combination of a large-gauge needle (22G) and high injection speed provides wider distribution within the CSF and more effective transport to the cranial regions. On the other hand, with a small-gauge needle (27G) and low injection speed, the drug remained more localized, and access to the upper spinal regions was limited. Additional parameters such as injection duration, direction, and flush applications were also observed to significantly affect distribution. CFD modeling reveals that injection parameters significantly affect drug dispersion patterns in spinal anesthesia. Optimizing these parameters may improve therapeutic outcomes and reduce complications. The model provides a foundation for developing personalized intrathecal injection protocols.
脊髓麻醉是外科手术中广泛使用的一种疼痛控制技术，需要药物在脑脊液（CSF）中有效分布以获得最佳效果。药物分布受注射参数（如针直径和注射速度）影响，如果这些参数未优化，可能会降低疗效或引起副作用。本研究使用计算流体动力学（CFD）研究这些参数如何影响脑脊液中的药物分布。利用MRI数据创建了一个解剖结构精确的脑脊液空间三维模型。在L4-L5椎体水平使用三种针尖（22G、25G、27G）和不同注射速率进行模拟。该模型包括心脏和呼吸周期引起的生理性脑脊液振荡。从空间分布和浓度随时间变化的角度分析药物扩散情况。研究结果表明，大口径针（22G）和高注射速度的组合可在脑脊液中提供更广泛的分布，并更有效地输送至颅部区域。另一方面，使用小口径针（27G）和低注射速度时，药物分布更局限，进入上脊髓区域受限。还观察到注射持续时间、方向和冲洗应用等其他参数对分布有显著影响。CFD建模表明，注射参数显著影响脊髓麻醉中药物的扩散模式。优化这些参数可能会改善治疗效果并减少并发症。该模型为制定个性化鞘内注射方案提供了基础。
