A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint

Abstract

Context:Combined spinal epidural anesthesia (CSEA) has a significant advantage by enabling the use of low dose intrathecal local anesthetic, with knowledge that the epidural catheter may be used to extend the block as necessary. CSEA is useful in high-risk geriatric patients by providing greater hemodynamic stability.Aim:This study is designed to compare the clinical effects of CSEA versus spinal anesthesia in high-risk geriatric patients undergoing surgeries around the hip joint.Materials and Methods:Sixty patients aged >65 years, American Society of Anaesthesiology III and IV were randomly allocated into two equal groups. Group A (n = 30) received CSEA with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 25 μg fentanyl through spinal route, and the expected incompleteness of spinal block was managed with small incremental dose of 0.5% isobaric bupivacaine through epidural catheter, 1–1.5 ml for every unblocked segment to achieve T10 sensory level. Group B (n = 30) received spinal anesthesia with 2.5 ml (12.5 mg) of 0.5% hyperbaric bupivacaine and 25 μg fentanyl.Result:Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (P < 0.01) along with the provision of prolonging analgesia as compared to Group B.Conclusion:CSEA is a safe, effective, reliable technique with better hemodynamic stability along with the provision of prolonging analgesia compared to spinal anesthesia for high-risk geriatric patients undergoing surgeries around the hip joint.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

“…Aging implicates a progressive loss of functional reserve in all systems, specially cardiopulmonary [22]. A feature of this population has a high prevalence of pre-operative medical problems and often need optimization before surgery [20]. Post operative complications are more common in geriatric patients [22].…”

“…Intravenous line with 18G I/V cannula was secured and a preload of 500 ml Ringer's lactate solution was given to every patient before giving regional anaesthesia. The degree of motor block of lower limbs was assessed bilaterally using Bromage Scale (1 = no motor block, 2 = can flex knee, move foot, but cannot raise leg, 3 = can move foot only, 4 = cannot move foot or knee) [20].…”

Efficacy of Unilateral Spinal Anaesthesia and Sequential Combined Spinal Epidural Anaesthesia for Surgery of Lower Limb - A Prospective and Comparative Study

“…This has also expanded popularity because of the diminutive onset time, while the catheter offers flexibility to permit the blockade to be stretched when desirable. [5,6] As disadvantages of both these techniques is still controversial in elderly as well as in ASA grade III patients, we conducted this study. [5,10] The incidence of double segment CSE method has 100% success rate compared to single segment needle-throughneedle CSE technique.…”

“…The sequential CSEA is being used for high risk geriatric patient posted for orthopaedic surgeries with better result and good haemodynamic stability. [5,6] Extensive Medline search revealed limited literature evaluation of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb OrthopaedicSurgery. Thus, we conducted a comparative study for evaluating the abovementioned techniques comparison on haemodynamic stability.…”

Low-dose combined spinal-epidural anesthesia for a patient with a giant hiatal hernia who underwent urological surgery

“…Spinal anesthesia causes hypotension because of a rapid increase in the block level, which can lead to nausea and vomiting, 4 and epidural anesthesia is delayed and shows inadequate motor block. 5 Therefore, an alternative anesthetic method for surgery is required in this situation.…”