1
|
Kim YH, Kwon SY, Jun EH, Choi ST, Park SJ, Kim Y. Comparison of epidural, spinal, and saddle block for holmium laser enucleation of prostate (HoLEP): A prospective randomized, comparative study. Medicine (Baltimore) 2021; 100:e27534. [PMID: 34678887 PMCID: PMC8542140 DOI: 10.1097/md.0000000000027534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostate hypertrophy. The aim of the present study was to compare regional anesthesia methods for HoLEP operation and to determine the optimal technique. METHODS Sixty patients with American Society of Anesthesiologists scores of I-III were randomly allocated into 3 groups. Patients in group E received an epidural block with 75 mg of bupivacaine plus 50 μg of fentanyl. In group S, 15 mg of bupivacaine and 50 μg fentanyl were used for spinal anesthesia. In group SA, patients received saddle block with 15 mg of bupivacaine and 50 μg of fentanyl. RESULTS Time to T10 dermatome block and to maximal level block were longest in group E (P < .05), and maximal sensorial block level was higher in group E than group SA (P < .05). There was a significant difference in postoperative motor block, but no difference in systolic blood pressure and heart rate. CONCLUSION Among 3 techniques, saddle block might be preferable in HoLEP because an adequate sensorial level was achieved with lower motor block and stable hemodynamics.
Collapse
Affiliation(s)
- Young Hoon Kim
- Department of Anesthesiology and pain medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - So Young Kwon
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Eun Hwa Jun
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Seung Tae Choi
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Seong Jin Park
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| | - Yumi Kim
- Department of Anesthesiology and pain medicine, St. Vincent's Hospital, College of Medicine, the Catholic University of Korea, Republic of Korea
| |
Collapse
|
2
|
Cho WJ, Yun SH, Oh JH, Lee K, Kim HJ. Comparison of the immediate hemodynamic changes induced by unilateral and bilateral spinal anesthesia in hypertensive elderly patients. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Woo Jin Cho
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - So Hui Yun
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ji Hun Oh
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Keumo Lee
- Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
3
|
Abstract
Unilateral spinal anesthesia is a cost-effective and rapidly performed anesthetic technique. An exclusively unilateral block only affects the sensory, motor and sympathetic functions on one side of the body and offers the advantages of a spinal block without the typical adverse side effects seen with a bilateral block. The lack of hypotension, in particular, makes unilateral spinal anesthesia suitable for patients with cardiovascular risk factors e. g. aortic valve stenosis or coronary artery disease. Increasing numbers of surgical procedures are now being performed on an outpatient basis. Until now, spinal anesthesia has been considered unsuitable for this, not only because of the high incidence of intraoperative hypotension and postoperative urinary retention but also because of the prolonged postoperative stay before home discharge. This is not the case with unilateral spinal anesthesia: motor function returns rapidly, the incidence of urinary retention is extremely low, and patients are usually eligible for home discharge sooner than after bilateral spinal anesthesia or general anesthesia. The success of the technique depends on a number of factors. In addition to the local anesthetic, its concentration and dose, and the baricity of the injected solution, the shape of the spinal needle, the injection speed, the patient's position during injection, and the time the patient remains in this position after injection are equally important parameters. A number of intrathecally applied adjuvant drugs are used to give a more intense and/or longer-lasting block. For this review, we collated the published data on unilateral spinal anesthesia from journals with an impact factor greater than 1.0 and defined an optimized method for performing the technique. In order to achieve an exclusively unilateral block one should use 0.5 % hyperbaric bupivacaine injected at a rate of 0.33 ml/min or slower. During the injection and the following 20 min the patient should lie in the lateral decubitus position on the side intended for surgery with knees drawn to the chest. An injection of 5 mg (1 ml) hyperbaric bupivacaine 0.5 % provides an hour-long block to T 12, and a dose of 7.5 to 10 mg (1.5-2.0 ml) extends the block to T 6. Adding clonidine (0.5 to 1.0 µg/kg BW) to the injection prolongs the duration of the block to approximately two to three hours. During the 20-minute fixation period, the cephalad spread of the block can be influenced to a certain extent by raising or lowering the head of the table.
Collapse
|
4
|
Boyacı BT, Arı DE, Peker TT, Baykal B. Comparison of Intraoperative and Postoperative Effects of Lateral Epidural and Midline Epidural Anaesthesia in Patients Undergoing Unilateral Lower Extremity Operation. Turk J Anaesthesiol Reanim 2016; 43:162-8. [PMID: 27366489 DOI: 10.5152/tjar.2015.30075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aimed to compare lateral and midline epidural anaesthesia using a levobupivacaine-fentanyl combination in patients undergoing unilateral lower extremity operation for anaesthetic effects and postoperative complications. METHODS The study included 40 American Society of Anesthesiologists (ASA) I-II group patients. At the L4-5 space, an epidural catheter was placed in patients in Group 1 by directing the tip of the needle at a 45-degree angle to the operation side and in Group 2 with the needle tip in the cephalad direction. Patients in both groups were administered a combination of 10 mL 0.5% levobupivacaine and 50 μg fentanyl via the epidural catheter. Sensorial and motor block levels during the perioperative and postoperative periods and postoperative complications were recorded. RESULTS The maximum level of sensory block on the operated side was found to be at the T10 (T8-T10) level in both groups, while the level of sensory block on the non-operated side was at the L2 (L3-T10) level in Group 1, and at the T10 (T8-T10) level in Group 2 (p=0.000). The motor block was more intense on the non-operated side in Group 2 than in Group 1. The postoperative motor block ended earlier in Group 1. The incidence of complication development was similar between the groups. CONCLUSION With a shorter lasting and lower level sensorial and motor block, lateral epidural anaesthesia may be a more advantageous method than midline epidural anaesthesia.
Collapse
Affiliation(s)
- Başak Tırak Boyacı
- Clinic of Anaesthesiology and Reanimation, Burdur State Hospital, Burdur, Turkey
| | - Dilek Erdoğan Arı
- Clinic of Anaesthesiology and Reanimation, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Tülay Tunçer Peker
- Department of Anaesthesiology and Reanimation, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Barbaros Baykal
- Department of Orthopedics and Traumatology, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| |
Collapse
|
5
|
Marx G, Schindler AW, Mosch C, Albers J, Bauer M, Gnass I, Hobohm C, Janssens U, Kluge S, Kranke P, Maurer T, Merz W, Neugebauer E, Quintel M, Senninger N, Trampisch HJ, Waydhas C, Wildenauer R, Zacharowski K, Eikermann M. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany. Eur J Anaesthesiol 2016; 33:488-521. [PMID: 27043493 PMCID: PMC4890839 DOI: 10.1097/eja.0000000000000447] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gernot Marx
- From the Department of Cardiothoracic and Vascular Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz (JA); Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena (MB); Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne (ME); Institute of Nursing Science and Practice, Paracelsus Private Medical University, Salzburg, Austria (IG); Department of Internal Medicine, Neurology and Dermatology, Leipzig University Hospital, Leibzig (CH); Department of Cardiology, St Antonius Hospital, Eschweiler (UJ); Centre for Intensive Care Medicine, Universitätsklinikum, Hamburg-Eppendorf (SK); Department of Anaesthesia and Critical Care, University Hospital of Würzburg, Würzburg (PK); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (GM); Urological Unit and Outpatient Clinic, University Hospital rechts der Isar, Munich (TM); Department of Obstetrics and Gynaecology, Bonn University Hospital, Bonn (WM); Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne (CM, EN); Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen (MQ); Department of Intensive and Intermediate Care Medicine, University Hospital of RWTH Aachen, Aachen (AWS); Department of General and Visceral Surgery, Münster University Hospital, Münster (NS); Department of Health Informatics, Biometry and Epidemiology, Ruhr-Universität Bochum, Bochum (HJT); Department of Trauma Surgery, Essen University Hospital, Essen (CW); Department of General Surgery, University Hospital of Würzburg, Würzburg (RW); and Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany (KZ)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Tomak Y, Erdivanli B, Sen A, Bostan H, Budak ET, Pergel A. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery. J Anesth 2015; 30:26-30. [DOI: 10.1007/s00540-015-2081-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
|
7
|
Bajwa SJS, Kulshrestha A, Jindal R. Co-loading or pre-loading for prevention of hypotension after spinal anaesthesia! a therapeutic dilemma. Anesth Essays Res 2015; 7:155-9. [PMID: 25885825 PMCID: PMC4173526 DOI: 10.4103/0259-1162.118943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuraxial blockade such as spinal anaesthesia can cause severe hypotension due to pharmacological sympathectomy resulting in potential deleterious consequences for the patient. Prevention of this spinal anaesthesia induced hypotension is of utmost importance especially in pregnant population as the life of mother as well as fetus is at risk. Several techniques and methodologies have been adopted for the prevention of this neuraxial hypotension with varying degree of success. The administration of intravenous fluids to optimize the blood volume during sympathectomy has been the most popular and widely used as the first line of therapy among these techniques. The intravenous fluids can be used both before and during the administration of spinal anaesthesia, the techniques appropriately named as pre-loading and co-loading respectively. Numerous research studies and available literary evidence suggests that both of these techniques can be equally effective in prevention of hypotension. The use of colloids has been observed to be more effective for pre-loading due to their longer half-life in the intravascular compartment. However, it has also been suggested that no technique is efficient in preventing the hypotension alone and has to be coupled with judicious use of vasopressors.
Collapse
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Ashish Kulshrestha
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Ravi Jindal
- Department of Anaesthesiology and Intensive Care, Amar Hospital, Patiala, Punjab, India
| |
Collapse
|
8
|
Ellakany MH. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery. Anesth Essays Res 2014; 8:223-8. [PMID: 25886230 PMCID: PMC4173607 DOI: 10.4103/0259-1162.134516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. BACKGROUND Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can't tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. MATERIALS AND METHODS A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. RESULTS Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. CONCLUSION This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay, better postoperative pain relief and patient satisfaction than general anesthesia.
Collapse
Affiliation(s)
- Mohamed Hamdy Ellakany
- Department of Anesthesia, Medical Research Institute, Alexandria University, Alexandria, Egypt
| |
Collapse
|
9
|
Bosmans T, Schauvliege S, Gasthuys F, Duchateau L, Steblaj B, Gadeyne C, Polis I. Influence of a preload of hydroxyethylstarch 6% on the cardiovascular effects of epidural administration of ropivacaine 0.75% in anaesthetized dogs. Vet Anaesth Analg 2011; 38:494-504. [DOI: 10.1111/j.1467-2995.2011.00633.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Ulker B, Erbay RH, Serin S, Sungurtekin H. Comparison of Spinal, Low-Dose Spinal and Epidural Anesthesia With Ropivacaine Plus Fentanyl for Transurethral Surgical Procedures. Kaohsiung J Med Sci 2010; 26:167-74. [DOI: 10.1016/s1607-551x(10)70025-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022] Open
|
11
|
Zorko N, Kamenik M, Starc V. The effect of Trendelenburg position, lactated Ringer's solution and 6% hydroxyethyl starch solution on cardiac output after spinal anesthesia. Anesth Analg 2009; 108:655-9. [PMID: 19151304 DOI: 10.1213/ane.0b013e31818ec9e5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of our study was to evaluate the effects of Trendelenburg position, infusion of 6% hydroxyetyl starch solution or lactated Ringer's solution on changes in cardiac output (CO) after spinal anesthesia in patients older than 50 yr. METHODS Seventy patients scheduled for lower extremity orthopedic surgery under spinal anesthesia were allocated randomly to one of the three treatment groups. In the Trendelenburg group, the patients were placed in the Trendelenburg position immediately after the spinal block for 10 min. In the hydroxyethyl starch group and the lactated Ringer's group, the patients received an infusion of 500 mL of 6% hydroxyethyl starch solution or 1000 mL of lactated Ringer's solution over 20 min after the spinal block. CO was measured continuously from 15 min before until 30 min after spinal anesthesia using the impedance cardiography method and arterial blood pressure with an automated device. P < 0.05 was considered statistically significant. RESULTS The differences among treatment groups in CO were not statistically significant. Differences in the CO changes from baseline over time were significant. In the Trendelenburg group, CO did not change while the patient was in the Trendelenburg position. In the hydroxyethyl starch group, CO increased significantly after the block and remained significantly increased until the end of measurements. In the lactated Ringer's group, CO increased significantly 10 and 20 min after the block but, after stopping the infusion, CO started to decrease. CONCLUSIONS Our study demonstrated that a decrease in CO after spinal anesthesia is prevented by placing the patient in the Trendelenburg position, or infusion of either lactated Ringer's solution or 6% hydroxyetyl starch solution. Although the effects of the infusion of the lactated Ringer's solution are transient, the effects of the infusion of 6% hydroxyethyl starch solution are extended beyond the time the infusion.
Collapse
Affiliation(s)
- Nusa Zorko
- Department of Anesthesiology, Intensive Care and Pain Management, University Medical Center Maribor, Ljubljanska 5, 2000 Maribor, Slovenia, Europe
| | | | | |
Collapse
|
12
|
Bigat Z, Boztug N, Karsli B, Cete N, Ertok E. Comparison of Hyperbaric Ropivacaine and Hyperbaric Bupivacaine in Unilateral Spinal Anaesthesia. Clin Drug Investig 2006; 26:35-41. [PMID: 17163233 DOI: 10.2165/00044011-200626010-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND To evaluate the clinical efficacy and safety of unilateral spinal anaesthesia with 0.66% hyperbaric ropivacaine compared with 0.5% hyperbaric bupivacaine for arthroscopic knee surgery. PATIENTS AND METHODS Forty patients with American Society of Anesthesiology physical status grade I-II were randomly and double blindly allocated to one of two groups. Spinal anaesthesia was performed from the L3-4 or L4-5 interspace with the patient in the lateral decubitus position and with the operative side below. Group B (n = 20) received 7.5 mg of 0.5% hyperbaric bupivacaine and group R (n = 20) received 10 mg of 0.66% hyperbaric ropivacaine. Patients stayed in the lateral decubitus position for 10 minutes and were then turned to the supine position. The characteristics of spinal block, intraoperative quality of spinal anaesthesia, adverse effects and recovery times were recorded. RESULTS The onset of sensory block and motor block were significantly earlier in group B compared with group R (p < 0.05). The duration of sensory block and motor block were significantly shorter for group R compared with group B (p < 0.05). Bilateral sensory block occurred in 85% of patients in group B and in 40% of patients in group R (p < 0.05). Bilateral motor block occurred in 70% of patients in group B and in 25% of patients in group R (p < 0.05). CONCLUSION For outpatient knee arthroscopy, 10 mg of 0.66% hyperbaric ropivacaine is preferred to 7.5 mg of 0.5% hyperbaric bupivacaine because it provides a more selective unilateral block and a faster recovery.
Collapse
Affiliation(s)
- Zekiye Bigat
- Department of Anaesthesiology and Reanimation, Akdeniz University Hospital, Antalya, Turkey.
| | | | | | | | | |
Collapse
|
13
|
Borghi B, Agnoletti V, Ricci A, van Oven H, Montone N, Casati A. A Prospective, Randomized Evaluation of the Effects of Epidural Needle Rotation on the Distribution of Epidural Block. Anesth Analg 2004; 98:1473-8, table of contents. [PMID: 15105234 DOI: 10.1213/01.ane.0000111113.45743.b8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We evaluated the effects of turning the tip of the Tuohy needle 45 degrees toward the operative side before threading the epidural catheter (45 degrees -rotation group, n = 24) as compared to a conventional insertion technique with the tip of the Tuohy needle oriented at 90 degrees cephalad (control group, n = 24) on the distribution of 10 mL of 0.75% ropivacaine with 10 microg sufentanil in 48 patients undergoing total hip replacement. The catheter was introduced 3 to 4 cm beyond the tip of the Tuohy needle. A blinded observer recorded sensory and motor blocks on both sides, quality of analgesia, and volumes of local anesthetic used during the first 48 h of patient-controlled epidural analgesia. Readiness to surgery required 21 +/- 6 min in the control group and 17 +/- 7 min in the 45 degree-rotation group (P > 0.50). The maximum sensory level reached on the operative side was T10 (T10-7) in the control group and T9 (T10-6) in the 45 degree-rotation group (P > 0.50); whereas the maximum sensory level reached on the nonoperative side was T10 (T12-9) in the control group and L3 (L5-T12) in the 45 degree-rotation group (P = 0.0005). Complete motor blockade of the operative limb was achieved earlier in the 45 degree-rotation than in the control group, and motor block of the nonoperative side was more intense in patients in the control group. Two-segment regression of sensory level on the surgical side was similar in the two groups, but occurred earlier on the nonoperative side in the 45 degree-rotation group (94 +/- 70 min) than in the control group (178 +/- 40 min) (P = 0.0005). Postoperative analgesia was similar in the 2 groups, but the 45 degree-rotation group consumed less local anesthetic (242 +/- 35 mL) than the control group (297 +/- 60 mL) (P = 0.0005). We conclude that the rotation of the Tuohy introducer needle 45 degrees toward the operative side before threading the epidural catheter provides a preferential distribution of sensory and motor block toward the operative side, reducing the volume of local anesthetic solution required to maintain postoperative analgesia. IMPLICATIONS Turning the Tuohy introducer needle 45 degrees toward the operative side before threading the epidural catheter is a simple maneuver that produces a preferential distribution of epidural anesthesia and analgesia toward the operative side, minimizing the volume of local anesthetic required to provide adequate pain relief after total hip arthroplasty.
Collapse
Affiliation(s)
- Battista Borghi
- Anesthesia Research Staff, IRCCS Istituti Ortopedici Rizzoli, Bologna, Italy
| | | | | | | | | | | |
Collapse
|
14
|
Mojica JL, Meléndez HJ, Bautista LE. The timing of intravenous crystalloid administration and incidence of cardiovascular side effects during spinal anesthesia: the results from a randomized controlled trial. Anesth Analg 2002; 94:432-7, table of contents. [PMID: 11812714 DOI: 10.1097/00000539-200202000-00039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We conducted a randomized clinical trial to evaluate the efficacy of crystalloids in preventing spinal-induced hypotension (SIH) and cardiovascular side effects (CVSE) in a group of surgical patients. Participants were assigned to receive lactated Ringer's solution at 1-2 mL/min (Placebo group, n = 142); lactated Ringer's at 20 mL/kg starting 20 min before spinal block (n = 130); or lactated Ringer's at 20 mL/kg starting at the time of spinal block (n = 132). SIH was defined as a decrease of > or = 30% in baseline systolic blood pressure, and CVSE as SIH plus nausea, vomiting, or faintness requiring treatment. The incidence of SIH was similar in all treatment groups. Compared to placebo, crystalloid administration at the time of spinal block resulted in a significant reduction in the proportion of patients developing CVSE from 9.9% to 2.3%. The corresponding relative proportion was 0.23 (95% confidence interval, 0.07-0.78; P = 0.019), and one additional case of CVSE was avoided for each 13 patients receiving crystalloids at the time of spinal block instead of placebo. Administration of crystalloids at the time of spinal block seems to be effective because it provides additional intravascular fluids during the period of highest risk of CVSE after spinal anesthesia. IMPLICATIONS Crystalloids are frequently administered to nonobstetric patients minutes before spinal anesthesia to prevent cardiovascular side effects (CVSE). This randomized controlled trial shows that although crystalloids administered before spinal block result in no clinical benefit, they significantly reduce the risk of CVSE when administered at the time of spinal block.
Collapse
Affiliation(s)
- José L Mojica
- Department of Surgery, School of Medicine, Universidad Industrial de Santander
| | | | | |
Collapse
|
15
|
Mojica JL, Meléndez HJ, Bautista LE. The Timing of Intravenous Crystalloid Administration and Incidence of Cardiovascular Side Effects During Spinal Anesthesia: The Results from a Randomized Controlled Trial. Anesth Analg 2002. [DOI: 10.1213/00000539-200202000-00039] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Kamenik M, Paver-Erzen V. The effects of lactated Ringer's solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg 2001; 92:710-4. [PMID: 11226106 DOI: 10.1097/00000539-200103000-00030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We evaluated the effects of an infusion of lactated Ringer's (LR) solution on changes in cardiac output (CO) after spinal anesthesia. Seventy-five patients scheduled for lower extremity surgery under spinal anesthesia were studied. We measured CO (impedance cardiography method) and blood pressure for 25 min before and 30 min after spinal anesthesia. Patients were randomly assigned to three groups. In the No Infusion group, no LR solution was given during the period of measurements. The LR Before group received 12 mL/kg of LR solution within 20 min before spinal anesthesia. The LR After group received 12 mL/kg of LR solution within 20 min starting immediately after spinal anesthesia. After spinal anesthesia, CO decreased by 13.9% in the No Infusion group. In the LR Before group, CO increased after the infusion by 20% and returned to baseline value 30 min after spinal anesthesia. In the LR After group, CO increased after spinal anesthesia, and 30 min after spinal anesthesia, CO was 11.3% above baseline. We conclude that the decrease in CO after spinal anesthesia can be prevented by the infusion of an LR solution, with CO reaching the highest value while the infusion is running. IMPLICATIONS We studied the effects of lactated Ringer's solution infusion on cardiac output changes after spinal anesthesia. If the patients received no infusion, cardiac output decreased after spinal anesthesia. However, if the patients received lactated Ringer's solution infusion, cardiac output was maintained.
Collapse
Affiliation(s)
- M Kamenik
- Department of Anesthesiology, Intensive Care, and Pain Management, Maribor Teaching Hospital, Maribor, Slovenia.
| | | |
Collapse
|
17
|
Kamenik M, Paver-Eržen V. The Effects of Lactated Ringer’s Solution Infusion on Cardiac Output Changes After Spinal Anesthesia. Anesth Analg 2001. [DOI: 10.1213/00000539-200103000-00030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
18
|
Järvelä K, Honkonen SE, Järvelä T, Kööbi T, Kaukinen S. The comparison of hypertonic saline (7.5%) and normal saline (0.9%) for initial fluid administration before spinal anesthesia. Anesth Analg 2000; 91:1461-5. [PMID: 11094001 DOI: 10.1097/00000539-200012000-00031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertonic saline can be used for initial fluid administration before spinal anesthesia. It is effective in small-volume fluid resuscitation. This randomized double-blinded study compared the effects of 7.5% hypertonic saline (HS) and 0.9% normal saline (NS) in doses containing 2 mmol/kg of sodium in 40 ASA physical status I-II patients undergoing arthroscopy or other lower limb surgery under spinal anesthesia. We infused 1.6 mL/kg of HS or 13 mL/kg of NS for initial fluid administration before spinal anesthesia induced with a 10-mg dose of 0.5% hyperbaric bupivacaine. Etilefrine was administered to maintain mean arterial pressure at > or =80% of its control value. Systolic and diastolic blood pressure, heart rate, and cardiac index did not differ between the groups, and the amount of etilefrine administered was similar in the treatment groups. In all our patients, the plasma sodium concentrations were within the normal range after surgery and serum osmolality was within the normal range after spinal anesthesia. The time and the volume of the first micturition were similar in both groups, despite the much smaller amount of infused free water in the HS group. We conclude that 7.5% HS was as good as NS for the initial fluid administration before spinal anesthesia when the amount of sodium was kept unchanged.
Collapse
Affiliation(s)
- K Järvelä
- Department of Anaesthesia and Intensive Care, Tampere University Hospital, Tampere, Finland
| | | | | | | | | |
Collapse
|
19
|
Kamenik M. The influence of left lateral position on cardiac output changes after head up tilt measured by impedance cardiography. J Clin Monit Comput 1999; 15:519-23. [PMID: 12578050 DOI: 10.1023/a:1009968513512] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The value of the impedance cardiography (IC) method for measuring cardiac output (CO) with the subject in the left lateral position has not yet been established. We compared the CO after a 30 degrees head-up tilt with the subjects in the supine and left lateral position. METHODS Thirty healthy young volunteers were placed in the supine horizontal position. CO, stroke volume (SV) and heart rate (HR) were measured for five minutes using impedance cardiography (NCOMM3, BoMed Medical Manufacturing, Location). Then a 30 degrees head-up tilt was done and the measurements were continued for an additional five minutes. After that the subjects were placed in the left lateral horizontal position and the measuring procedure was repeated. RESULTS After the tilt, SV and cardiac index (CI) decreased and HR increased statistically significantly in the supine and in the left lateral position. SV and CI also decreased statistically significantly but HR did not change after the shift from the supine to the left lateral position. Although CI was smaller in the left lateral position, the time course of CI change after the tilt was identical in the supine and in the left lateral position. CONCLUSION When using the IC method of SV measurement, the absolute value of the CI changes when moving from the supine to lateral positions. It is not clear whether this change is physiologic or an artifact of the measurement technique. However, changes in CI in response to a 30 degree head up tilt are the same in either position. We conclude that changes in CI can be measured with the IC method in the lateral position.
Collapse
Affiliation(s)
- M Kamenik
- Department of Anesthesiology, Intensive Care and Pain Management, Maribor Teaching Hospital, Maribor, Slovenia.
| |
Collapse
|
20
|
Abstract
The results of different studies investigating the use of unilateral spinal anaesthesia are confusing and partly inconsistent. Some authors doubt whether it is possible to create a strictly unilateral block (i.e. motor, sensory and sympathetic) at all, while others claim that such a procedure is standard, especially for ambulatory anaesthesia. This review considers those factors which are relevant, plausible and proven.
Collapse
Affiliation(s)
- D Enk
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin der Westfälischen Wilhelms-Universität, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany
| |
Collapse
|
21
|
Casati A, Fanelli G, Cappelleri G, Borghi B, Cedrati V, Torri G. Low dose hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth 1998; 45:850-4. [PMID: 9818107 DOI: 10.1007/bf03012218] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the effects of hyperbaric bupivacaine concentration in producing unilateral spinal anaesthesia. METHODS With Ethical Committee approval and written consent, 60 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent. After dural puncture (25-gauge Whitacre spinal needle), the needle hole was turned toward the dependent side and patients were randomly assigned to receive 8 mg of either 0.5% (Group0.5%, n = 30) or 1% (Group1%, n = 30) hyperbaric bupivacaine. The lateral position was maintained for 15 min, while a blinded observer recorded loss of pinprick sensation and degree of motor block on both sides until two segment regression of sensory level on the dependent side. RESULTS At the end of the 15 min lateral position spinal anaesthesia was more frequently unilateral in Group0.5% (80%) than in Group1% (53%)(P < 0.05). However, 30 min after patients were turned supine, unilateral spinal anaesthesia decreased to 60% of cases in Group0.5% and 40% of cases in Group1% (P = NS). The maximum sensory level on the dependent side [T10(L1-T2) in Group0.5% and T8 (T12-T3) in Group1%], time to reach it [20 (5-30) min in Group0.5% and 25 (10-35) min in Group1%], and time to two segment regression of sensory level [80 (30-135) min in Group0.5% and 75 (20-135) min in Group1%] were similar in both groups. CONCLUSION Highly concentrated solutions of hyperbaric bupivacaine are not advantageous in obtaining a unilateral spinal anaesthesia, when a small anaesthetic dose is injected slowly through a Whitacre spinal needle.
Collapse
Affiliation(s)
- A Casati
- University of Milan, Department of Anaesthesiology and Intensive Care, IRCCS H San Raffaele, Italy.
| | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Casati A, Fanelli G, Cappelleri G, Aldegheri G, Leoni A, Casaletti E, Torri G. Effects of spinal needle type on lateral distribution of 0.5% hyperbaric bupivacaine. Anesth Analg 1998; 87:355-9. [PMID: 9706930 DOI: 10.1097/00000539-199808000-00022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED To evaluate the influence of needle type on the lateral distribution of 0.5% hyperbaric bupivacaine, 30 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent and underwent dural puncture by either a 25-gauge Whitacre (n = 15) or a 25-gauge Quincke (n = 15) spinal needle. The needle hole was turned toward the dependent side and 8 mg of 0.5% hyperbaric bupivacaine was injected over 30 s. The lateral position was maintained for 15 min while a blind observer recorded loss of pinprick sensation and degree of motor block on both the dependent and nondependent sides every 5 min until regression of motor block by 1 degree on the dependent side. Thirty minutes after the patients were placed in the supine position, unilateral sensory block was observed in 10 patients in the Whitacre group (66%) and in 2 patients in the Quincke group (13%) (P < 0.05). No differences in the rate of unilateral motor block were observed (73% and 40% in Whitacre and Quincke groups, respectively). We conclude that when a small dose of 0.5% hyperbaric bupivacaine is injected slowly into patients in the lateral position for 15 min, the Whitacre spinal needle provides a more marked differential block of sensory nerve roots between dependent and nondependent sides compared with the Quincke needle. IMPLICATIONS Because unilateral spinal anesthesia can be advantageous for lower limb surgery, we evaluated the influence of the Whitacre and Quincke spinal needle types on the lateral distribution of small-dose 0.5% hyperbaric bupivacaine injected slowly into adult patients.
Collapse
Affiliation(s)
- A Casati
- Department of Anesthesiology and Intensive Care, University of Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
24
|
A transient neurological deficit following intrathecal injection of 1% hyperbaric bupivacaine for unilateral spinal anaesthesia. Eur J Anaesthesiol 1998. [DOI: 10.1097/00003643-199801000-00021] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, Torri G. Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. Acta Anaesthesiol Scand 1998; 42:80-4. [PMID: 9527749 DOI: 10.1111/j.1399-6576.1998.tb05084.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiovascular function was assessed in 20 ASA I-II patients, scheduled for elective orthopaedic surgery with tourniquet in order to compare the haemodynamic changes induced by unilateral spinal anaesthesia and combined sciatico-femoral nerve block. METHODS After baseline measurement of cardiovascular parameters, patients were randomized to receive unilateral spinal anaesthesia or combined sciatico-femoral nerve block. Spinal anaesthesia was obtained by 8 mg of hyperbaric bupivacaine 0.5% slowly injected (speed=0.02 ml s[-1]) through a 25-G Whitacre spinal needle with the bevel orientated towards the dependent side and patients lying on their operated side for 15 min (group S, n=10). Combined sciatico-femoral nerve block was obtained by 7 mg kg(-1) of mepivacaine 2% (group NB, n=10). Haemodynamic variables were recorded 5, 10, 15, and 30 min after anaesthetic injection before surgery was started. RESULTS Anthropometric data, duration of surgery and acceptability of anaesthetic techniques were similar in the 2 groups. In 8 patients of group S, spinal block was restricted to the operated side (pinprick test and Bromage scale), while the other 2 patients developed bilateral spinal block after being turned supine. NB patients showed no haemodynamic changes during the study, whereas patients in group S showed a small but significant decrease of mean arterial blood pressure (P<0.002 vs baseline and P<0.04 vs NB), cardiac index (P<0.01 vs baseline and P<0.01 vs NB), and stroke volume index (P<0.01 vs baseline and P<0.01 vs NB). CONCLUSION Both sciatico-femoral and unilateral spinal blockade provide adequate anaesthesia for unilateral leg surgery with tourniquet. The former technique affects cardiovascular performance less than the latter one.
Collapse
Affiliation(s)
- G Fanelli
- Department of Anaesthesiology and Intensive Care, IRCCS H San Raffaele, University of Milan, Italy
| | | | | | | | | | | | | |
Collapse
|