Jyoti Sandeep Magar1, Kishori Dhaku Bawdane2, Rahul Patil3. 1. Associate Professor, Department of Anaesthesia, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. 2. Assistant Professor, Department of Anaesthesia, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. 3. Registrar, Department of Anaesthesia, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
Abstract
INTRODUCTION: Orthopaedic anaesthesia plan requires customi-zation as per patient's need for safe outcome. Sequential Combined Spinal Epidural Anaesthesia (Sequential CSEA) and Unilateral Single Shot Spinal anaesthesia (Unilateral SA), both have advantages over conventional spinal anaesthesia that they provide longer lasting block with less hypotension. AIM: To compare safety and efficacy of unilateral spinal anaesthesia with sequential combined spinal epidural anaesthesia for lower limb orthopaedic surgery . MATERIALS AND METHODS: This prospective randomized study was conducted on sixtyASA I-III patients aged 18- 65 years undergoing lower limb orthopaedic surgeries of approximately two hours duration. Sequential CSE group received spinal with 5 mg of 0.5 hyperbaric bupivacaine followed by incremental epidural top up of 2 cc of 0.5% isobaric bupivacaine to achieve and maintain T10 level. In unilateral SA group, unilateral spinal anaesthesia was given with 10 mg of 0.5% hyperbaric bupivacaine. Haemodynamic parameter, anaesthesia readiness time and block characteristics were recorded and results were analysed using unpaired Student's t-test. RESULTS: There was no failure of block, surgical anaesthesia with T10 sensory level and bromage score three motor block was achieved by all patients in both groups. Anaesthesia readiness time was less in unilateral SA (p<0.001) Incidences of hypotension (p-value 0.0059) and mean ephedrine dose were significantly less in sequential CSEA. Five patients of unilateral SA required supplementation with general anaesthesia. CONCLUSION: Thus, our study concludes that unilateral SA is a cost-effective and rapidly performed anaesthetic technique. Unilateral SA with 10 mg bupivacaine and sequential CSEA with 5 mg spinal and incremental epidural top up, both provide good quality sensory and motor block for lower limb orthopaedic surgery but sequential CSEA provides significantly more stable haemodynamics with feasibility to prolong block. Thus sequential CSEA should be preferred over unilateral SA in high risk patients especially for major lower limb orthopaedic surgeries.
RCT Entities:
INTRODUCTION: Orthopaedic anaesthesia plan requires customi-zation as per patient's need for safe outcome. Sequential Combined Spinal Epidural Anaesthesia (Sequential CSEA) and Unilateral Single Shot Spinal anaesthesia (Unilateral SA), both have advantages over conventional spinal anaesthesia that they provide longer lasting block with less hypotension. AIM: To compare safety and efficacy of unilateral spinal anaesthesia with sequential combined spinal epidural anaesthesia for lower limb orthopaedic surgery . MATERIALS AND METHODS: This prospective randomized study was conducted on sixty ASA I-III patients aged 18- 65 years undergoing lower limb orthopaedic surgeries of approximately two hours duration. Sequential CSE group received spinal with 5 mg of 0.5 hyperbaric bupivacaine followed by incremental epidural top up of 2 cc of 0.5% isobaric bupivacaine to achieve and maintain T10 level. In unilateral SA group, unilateral spinal anaesthesia was given with 10 mg of 0.5% hyperbaric bupivacaine. Haemodynamic parameter, anaesthesia readiness time and block characteristics were recorded and results were analysed using unpaired Student's t-test. RESULTS: There was no failure of block, surgical anaesthesia with T10 sensory level and bromage score three motor block was achieved by all patients in both groups. Anaesthesia readiness time was less in unilateral SA (p<0.001) Incidences of hypotension (p-value 0.0059) and mean ephedrine dose were significantly less in sequential CSEA. Five patients of unilateral SA required supplementation with general anaesthesia. CONCLUSION: Thus, our study concludes that unilateral SA is a cost-effective and rapidly performed anaesthetic technique. Unilateral SA with 10 mg bupivacaine and sequential CSEA with 5 mg spinal and incremental epidural top up, both provide good quality sensory and motor block for lower limb orthopaedic surgery but sequential CSEA provides significantly more stable haemodynamics with feasibility to prolong block. Thus sequential CSEA should be preferred over unilateral SA in high risk patients especially for major lower limb orthopaedic surgeries.
Authors: Mark D Neuman; Jeffrey H Silber; Nabil M Elkassabany; Justin M Ludwig; Lee A Fleisher Journal: Anesthesiology Date: 2012-07 Impact factor: 7.892