Can mode of anaesthesia interfere with the discharge in patients undergoing day care ureteroscopic surgeries? A randomized control trial comparing general with spinal anaesthesia

Abstract

Background & Aim: Improvement in Surgical and Anaesthetic techniques allows even complex surgeries to be performed as day care cases. The objective of the study is to compare the recovery parameters of patients undergoing anaesthesia for ambulatory surgeries under General or Spinal Anaesthesia. Materials and Methods: After approval by IEC, this study was performed in 60 patients undergoing elective ureteroscopic procedures. Patients were Randomized to receive either General anaesthesia (Group GA: n=30) or Spinal Anaesthesia (Group GA: n=30). GA was induced using standard protocols with airway maintained spontaneously using LMA. In group SA patients received 1.5 ml 0.75% Isobaric Ropivacaine for providing anaesthesia. Vitals were recorded in both the groups throughout the procedure. In addition to intra operative haemodynamics, the onset of duration and percentage of patients achieving complete sensory & motor block was also recorded in SA group. Patients were kept in phase I recovery till score of Aldrete 9 was reached. In phase II recovery (PACU) the percentage of patients sitting at 180 min, standing at 300 min and walking at 360 min were recorded. The psychomotor skills of patients were assessed using digit symbol substitution test (DSST) before discharging from phase II recovery. The main criteria for discharging patients from phase II recovery was Post Anaesthesia Discharge scoring (PADSS). Patients were discharged from phase II recovery on reaching PADSS <10. Results: Seventy three patients were enrolled and 60 patients completed the study. The onset of sensory and motor block in Group SA was 6.61±0.83 min and the onset of motor block was 9.48±0.91 min. Percentage of patients achieving complete sensory & motor block was 71%. The duration of sensory block was 208± 17.95 min and the duration of motor block was 182.07±15.98. Patients in group GA took 221.07± 4.97 and Group SA took 110.72± 7.04 min to reach Aldrete score of 10 (p value <0.05). At 180 min only 22.33% patients in group GA were able to sit, while in Group SA it was 70 (p value <0.05). The comfort score assessed by surgeon was excellent in group GA (4/4) and was only satisfactory (2/4) in Group SA. There was no difference in pain perception or PADSS at 360 min or psychomotor skills tested by Digital symbol substitution test (DSST). Conclusion: The technique of Anaesthesia doesn't interfere with readiness of patients to discharge home in terms of maintain stable vitals, pain or side effects. Isobaric Ropivacaine was found to be a poor choice for providing spinal anaesthesia due to slow onset of sensory block, inability to achieve complete motor block thus providing difficulty to operating surgeon.