Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients

Abstract

The intraoperative effects of continuous spinal anaesthesia, and the efficacy of postoperative continuous spinal analgesia in 48 elderly high risk patients undergoing major abdominal, vascular or orthopaedic surgery is reported. Intraoperative anaesthetic technique proved to be safe and provided satisfactory results in the immediate postoperative period. Furthermore, the postoperative analgesic regimen which involved intrathecal fentanyl and bupivacaine, and intravenous tenoxicam, provided effective analgesia for all patients. The intrathecal analgesic regimen was administered continuously through a PCA pump which had the facility to provide bolus doses when requested in predetermined lockout intervals. The mean doses of fentanyl and bupivacaine infused intrathecally for the first 24 h postoperatively were 14.5 +/- 1.5 microg h(-1) (mean +/- SD) and 0.72 +/- 0.08 mg h(-1) (mean +/- SD), respectively, while the requirements for analgesia decreased progressively overtime but lasted for 118 h. The technique provided effective analgesia with low pain scores that was reflected by the ease in performing physical exercises and the pleasant co-operation with the physiotherapist. Only minor complications related to anaesthesia/analgesia were encountered.

Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

“…It allows titration of the dose according to surgical needs and provides safe anesthesia, with minimal amounts of drugs and greater hemodynamic stability than provided by single-dose spinal anesthesia, particularly among elderly or high-risk surgical patients. 5,6 OBJECTIVES In this prospective clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip, femoral or knee surgery.…”

Continuous spinal anaesthesia: A retrospective analysis of 318 cases

“…The demographic profiles were fairly similar to other studies. [ 15 17 19 20 ] Charlson comorbidity scoring index contains 19 categories of comorbidity and predicts the 1-year mortality for a patient who has a range of comorbid conditions. [ 12 ] This scoring index has been widely cited by nearly 3000 papers till date describing various comorbidities and mortality risk.…”

“…Some studies utilised the spinal catheter for post-operative analgesia for abdominal, vascular and hip surgery[ 20 30 ] but this was not practiced in our institution and all catheters were removed at the end of surgery. CSA has also been used in parturient and it has also been shown to be highly useful in many obstetric situations[ 31 32 ] such as previous spinal surgery, significant cardiac disease, morbid obesity, difficult airway and difficult epidural catheter placement.…”

Continuous Spinal Anesthesia for Hip Fracture Surgery in a very Old Patient With Pulmoner Hypertension

“…They reported similar sensory and motor blocks, haemodynamic changes and ephedrine requirements in two techniques. Conversely, Michaloudis et al [8] investigated the efficacy and safety of CSA for elderly or high-risk surgical patients undergoing major prolonged surgical procedures. It was concluded that CSA provides safe intraoperative anaesthesia and effective postoperative analgesia with minimal side effects in elderly or highrisk surgical patients.…”