Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

Magar, Jyoti; Bawdane, Kishori Dhaku; Patil, R. N.

doi:10.7860/jcdr/2017/26235.10215

Cited by 7 publications

(8 citation statements)

References 14 publications

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“…The findings were statistically significant (P=0.0001). Similar findings were obtained by Magar et al while studying unilateral spinal anesthesia [ 21 ]. This study found that the reverse Trendelenburg position limited the number of spinal segments blocked.…”

Section: Discussionsupporting

confidence: 90%

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10-degree reverse Trendelenburg position on hemodynamic parameters and block characteristics in unilateral spinal anesthesia in below knee orthopedic surgeries – can head up position do the trick?

Bhandari¹,

Kumar²,

Thakur³

et al. 2022

JMedLife

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Unilateral spinal anesthesia (USpA) is a technique used to restrict the effect of the spinal block on the operative side. 10–15 degrees reverse Trendelenburg position has been used to control the height of the spinal block using hyperbaric drugs. We aimed to study the effect of the 10-degree reverse Trendelenburg position on the quality of block and hemodynamic stability in unilateral spinal anesthesia in this hospital-based, double-blind, randomized clinical trial. 60 patients of both sexes between 20–60 years of age, undergoing below-knee orthopedic surgeries, were randomized into 2 groups. In both groups, spinal anesthesia was given with 2 mL bupivacaine heavy (0.5%), and the lateral position was maintained for 10 mins. Group 2 patients were kept in a 10-degree reverse Trendelenburg position throughout the surgery. The hemodynamic parameters and block characteristics of the two groups were compared using Epi Info statistical software. The onset of sensory block was faster in Group 1 (recumbent) compared to Group 2 (reverse Trendelenburg). The two-segment regression time was longer in the second group. In group 2, 73.3% of patients reached a level at T8 or below T8, compared to 46.7% in Group 1. The duration of sensory block and anesthesia was longer in Group 2. We conclude that reverse Trendelenburg of 10 degrees immediately after spinal anesthesia significantly limits the level of sensory block and prolongs the duration of unilateral spinal anesthesia.

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Section: Discussionsupporting

confidence: 90%

“…The analgesia duration was also substantially prolonged in the reverse Trendelenburg group. This research was assisted by a similar work [ 21 ]. Group 2 did not require vasopressors, whereas 4 patients in Group 1 required vasopressors for hypotension.…”

Section: Discussionmentioning

confidence: 99%

10-degree reverse Trendelenburg position on hemodynamic parameters and block characteristics in unilateral spinal anesthesia in below knee orthopedic surgeries – can head up position do the trick?

Bhandari¹,

Kumar²,

Thakur³

et al. 2022

JMedLife

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“…In the study by Jyoti Sandeep Magar et al, full recovery time of motor bock was measured as mean 2.5 hours in patients who underwent lower leg surgery under spinal anesthesia. 20 In our study, mean full recovery time of motor bock was measured above 3.5 hours and motor block recovered when the knee and feet had the strength to perform full flexion. This result suggests that peripheral nerve block added to spinal anesthesia may cause extension in motor block duration.…”

Section: Discussionmentioning

confidence: 53%

The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial

Kaçmaz

Turhan

2021

Geriatr Orthop Surg Rehabil

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Introduction: Femoral Nerve Block (FNB) and Adductor Canal Block (ACB) methods, which are regional analgesic techniques, are successfully used in postoperative pain control after total knee arthroplasty. This study aimed to compare adductor canal block method that was preoperatively used and femoral nerve block method in total knee arthroplasty (TKA) patients who underwent spinal anesthesia in terms of factors effecting patient satisfaction and determine whether these methods were equally effective or not. Methods: A total of 80 patients between the ages of 60 and 75 who were in the American Society of Anesthesia (ASA) physical status of I-III were prospectively included in this randomized study. Patients (n = 40) who received FNB were called Group FNB and patients (n = 40) who received Adductor Canal Block were called Group ACB. Results: Although mean postoperative VAS values were lower in FNB group only in the first hour (p = 0.02) there was no significant difference between the groups in the third, fifth, seventh, ninth, 12th and 24th hours (p≥0.05). Although Bromage scores were lower in FNB group in the first, second, third, fourth and fifth hours there was no statistically significant difference between the groups (p≥0.05). When mobilization time, patient satisfaction level, time of first analgesia, intraoperative sedation need, and recovery time of sensorial block were compared no statistically significant difference was found (p≥0.05). Discussion: When ACB and FNB that are used for postoperative analgesia in patients who undergo total knee arthroplasty are compared in terms of factors affecting patient satisfaction it is observed that they result in the same level (non-inferiority) of patient satisfaction. Conclusion: We recommend the routine use of ACB method with FNB in total knee arthroplasty. More studies focusing especially on measuring patient satisfaction are needed.

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“…In lower limb orthopaedic surgeries, regional anesthesia especially spinal anaesthesia is often preferred over general anesthesia. 4 However, despite it being a simpler and faster method it is associated with a great risk of marked hypotension. While increased age is a risk factor for increased peri-operative death, presence of co-morbidities and invasiveness of surgery are also some factors that increase the chance of death in aged patients.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly patients due to reduced physiological compensatory mechanisms and decreased cardiac reserve are more susceptible to adrop in blood pressure. 4 Thus, most common side effects associated with this technique include hypotension and decreased heart rate (bradycardia). 3 It can be challenging to maintain adequate blood pressure in elderly patients while reaching the required level of sensory block.…”

Section: Introductionmentioning

confidence: 99%

Influence of injection rate of hyperbaric bupivacaine 0.75% on spinal anaesthesia in elderly patients with lower limb orthopaedic surgeries. A randomized controlled trial.

Faridi¹,

Mahmood²,

Rehman³

2019

TPMJ

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To determine the effect of speed of hyperbaric bupivacaine (0.75%) injection on clinical characteristics of spinal anaesthesia in elderly patients undergoing lower limb orthopaedic surgeries. Study Design: Prospective, randomized, double-blind study. Setting: This study was conducted in the operating theatre of Fauji Foundation Hospital, Rawalpindi. Period: August 2018 - March 2019. Materials and Methods: 60 elderly patients undergoing lower limb orthopaedic surgery were randomized into two groups based on injection rate (fast and slow). 1.5 ml of 0.75% hyperbaric bupivacaine was injected over 5 seconds (fast group) and 50 seconds (slow group). Study was undertaken after taking permission from institutional ethical review committee. Level of sensory block, motor block, and systolic blood pressure were recorded at pre-specified intervals. Incidences of hypotensive episode, nausea, phenylephrine and antiemetic use were also documented. Results: Our study did not reveal any difference in maximum level of sensory block attained (fast = median T4, interquartile range [T4–T6] vs slow = T4 [T4–T6], P = 0.77). There was no difference in mean time (minutes) to reach T10 sensory level (fast = 2.5 ± 1.2 vs slow = 2.2 ± 0.8, P = 0.27); maximum sensory level (fast = 4.2 ± 1.5 vs slow = 3.8 ± 1.2, P = 0.26) and maximum motor block level (min) (fast = 5.9 ± 1.4 vs slow = 5.7 ± 1.2, P = 0.56). The rate of hypotension (fast = 8/30 vs slow = 4/30, P = 0.33), nausea (fast = 5/30 vs slow = 3/30, P = 0.99) and phenylephrine use (fast = 5/30 vs slow = 3/30, P = 0.71) and antiemetic requirement (fast = 1/30 vs slow = 2/30, P = 0.99) was also alike. Conclusion: There is no effect of injection speed of intrathecal (0.75%) bupivacaine on the clinical features of spinal anaesthesia in older patients undergoing lower limb orthopedic surgery.

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Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

Cited by 7 publications

References 14 publications

10-degree reverse Trendelenburg position on hemodynamic parameters and block characteristics in unilateral spinal anesthesia in below knee orthopedic surgeries – can head up position do the trick?

10-degree reverse Trendelenburg position on hemodynamic parameters and block characteristics in unilateral spinal anesthesia in below knee orthopedic surgeries – can head up position do the trick?

The Effect of Femoral Nerve Block and Adductor Canal Block Methods on Patient Satisfaction in Unilateral Knee Arthroplasty: Randomized Non-Inferiority Trial

Influence of injection rate of hyperbaric bupivacaine 0.75% on spinal anaesthesia in elderly patients with lower limb orthopaedic surgeries. A randomized controlled trial.

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