Bedside Differentiation Between Cerebrospinal Fluid and Local Anesthetics: A Cross-Sectional Investigation into a Mandatory Patient Safety Practice During Regional Anesthesia

Background: Spinal anesthesia is a widely used regional anesthesia technique in surgical practice because of its rapid onset, effectiveness, and safety. Accurate identification of cerebrospinal fluid (CSF) during spinal anesthesia is essential to ensure proper drug administration and avoid procedural complications. However, differentiating CSF from local anesthetic solutions at the bedside may sometimes be challenging. Objectives: To evaluate bedside differentiation between cerebrospinal fluid and local anesthetics during spinal anesthesia and assess its role in patient safety. Methods: This cross-sectional study was conducted at Ad-din Sakina Medical College Hospital, Jashore, Bangladesh, from February to July 2025. A total of 112 patients undergoing spinal anesthesia were included. Data were collected using a structured data sheet during the procedure, recording demographic information, type of surgery, and bedside differentiation methods used to identify cerebrospinal fluid such as pH, Temperature & Flow rate assessment, Glucose estimation, Thiopental precipitant test was done, neurological complications observed. Data were analyzed using SPSS software, and results were presented using frequency, percentage, mean, and standard deviation. Result: Among 112 patients (mean age 39.6 ± 11.2 years), most were aged 31–40 years (30.4%), female (57.1%), and housewives (25.9%). Obstetric surgery (35.7%) was the most common procedure. Senior residents (41.1%) most often performed spinal anesthesia. The thiopentone test (32.1%) was the leading bedside differentiation method. Correct identification of CSF versus local anesthetic was achieved in 83.9% of cases, with most differentiations completed within 30–60 seconds (41.1%). No complications occurred in 82.1% of patients, while major complications occurred in 5.4%. Overall, 84.0% agreed that mandatory bedside differentiation is essential for patient safety. Conclusion: Bedside differentiation between cerebrospinal fluid and local anesthetics improves accuracy of spinal and epidural anesthesia and enhances patient safety during procedures.