The Effect of Injection Parameters on Drug Distribution for Spinal Anesthesia: A Numerical Approach.

Abstract

<b>Background:</b> 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). <b>Material Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.