Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study

Gudaitytė, Jūratė; Marchertienė, Irena Agnietė; Karbonskienė, Aurika; Saladžinskas, Žilvinas; Tamelis, Algimantas; Toker, Igoris; Pavalkis, Dainius

doi:10.1016/j.jclinane.2008.11.014

Cited by 26 publications

(14 citation statements)

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“…Excluding the patient with perirectal haematoma, who was admitted for 1 week, patients were discharged in < 2 days. Urinary retention, postoperative hypotension and delay in anaesthetic recovery could be attributed to spinal anaesthesia, not the surgical technique [13,14,21]. The study also shows an excellent degree of immediate postoperative patient satisfaction following the day-case procedure: 90% of patients expressed their situation as 'excellent' or 'good,' a similar result to that obtained by Beattie et al [7].…”

Section: Discussionsupporting

confidence: 81%

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Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse

et al. 2012

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Section: Discussionsupporting

confidence: 81%

“…We perform SA in the lithotomy position and under spinal anaesthesia. Favourable results have been recently reported with spinal anaesthesia in anorectal surgery [13,14].…”

Section: Discussionmentioning

confidence: 99%

Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse

et al. 2012

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“…By injecting low dose hyperbaric local anesthetic intrathecally in seated patients, it limits sympathetic block and allows earlier ambulation. 1 However, it doesn't offer prolonged analgesia, especially when sole local anesthetic is used.…”

Section: Introductionmentioning

confidence: 99%

“…Minimal effective dose of bupivacaine for SSB ranges from four to 7.5 mg; we used five mg. 1,8,20,21 The technique, low dosage, and lipophilic nature of dexmedetomidine might have contributed for the lack of increment in peak sensory block, number of blocked dermatomes and magnitude of motor block. This in turn explains the similarity between groups regarding time to void and urinary retention.…”

mentioning

confidence: 99%

Effects of Adding Intrathecal Dexmedetomidine to Hyperbaric Bupivacaine for Saddle Spinal Block in Adults Undergoing Peri-anal Surgeries

Gautam

Lama

Sharma

2018

J Nepal Health Res Council

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Background: Saddle spinal block is the first choice anesthetic technique for adults undergoing peri-anal surgeries. It prevents unnecessary high levels of analgesia and sympathetic block. However, it may not provide prolonged analgesia. This study aims to investigate analgesic effects of dexmedetomidine when added to hyperbaric bupivacaine in saddle spinal block.Methods: Fifty otherwise healthy adults scheduled for uncomplicated peri-anal surgery were randomly allocated into two equal groups in this double-blinded study. Group A received hyperbaric bupivacaine five milligrams; group B received hyperbaric bupivacaine five milligrams plus dexmedetomidine five micrograms intrathecally. Patients remained seated for ten minutes. Time to first analgesic request by patients was the primary end point. Onset and extent of sensory block, and, magnitude and duration of motor block were assessed. Post-operative analgesic consumption and side effects were studied for 24 hours. Student's t-test for quantitative variables and Chi-square test for categorical variables were used for statistical analysis.Results: Patients in group B had a significantly prolonged duration of analgesia (group B, 501 ± 306 minutes; group A, 284 ± 58 minutes) and significantly reduced analgesic requirement than patients in group A. Sensory block in first sacral dermatome appeared significantly earlier in group B. Peak sensory block, magnitude of motor block, and side effects were not significantly different between groups A and B. Conclusions:Dexmedetomidine as an intrathecal adjuvant to hyperbaric bupivacaine in saddle spinal block prolongs duration of analgesia and decreases analgesic requirement with no added side effects.

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“…According to Schmittner et al, spinal anaesthesia with a low dose of hyperbaric local anaesthetic is superior to general anaesthesia for colorectal procedures in terms of postoperative analgesic consumption, recovery time, the rate of postoperative complications and patient satisfaction [ 4 ]. A standardized selective spinal anaesthesia with a low dose of hyperbaric bupivacaine for anorectal surgery produces a sufficient level of sensory and motor block and the quality of anaesthesia with a shorter duration and faster recovery than the general anaesthesia or the conventional spinal anaesthesia [ 5 ]. A number of studies investigating haemodynamic changes in the prone position are limited and even more limited concerning lithotomy position [ 6 - 12 ].…”

Section: Introductionmentioning

confidence: 99%

Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial

2015

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BackgroundAlthough the prone position providing better exposure for anorectal surgery is required it can cause a reduction of cardiac output and cardiac index. The goal was to compare haemodynamic changes assessed by impedance cardiography during anorectal surgery under low-dose spinal anaesthesia in lithotomy and jack-knife position.MethodsThe prospective randomized controlled study included 104, ASA I-II adult patients admitted for elective minor anorectal surgery, assigned to be performed in lithotomy (groupL, n = 52) or jack-knife position (groupJ, n = 52). After arrival to operating room the standard monitoring, impedance cardiography device was connected to the patient, and the following variables were recorded: cardiac output, cardiac index, systemic vascular resistance, stroke index at times of arrival to operating room, placement for, start and end of surgery and placement to bed. Spinal block was made in the sitting position with 4 mg of 0.5% hyperbaric bupivacaine and 10 μg of Fentanyl injected over 2 min. Comparison was based on haemodynamic changes between and inside groups over time. Student’s t, chi square tests were used for statistical analysis with p < 0.05 regarded as statistically significant.ResultsThe reduction of cardiac output was statistically significant after placement of the patient into the prone position: from baseline 7.4+/−1.6 to 4.9+/−1.2 after placement for and 4.7+/−1.2 at the start and end of surgery (mean +/−SD l/min). The difference of cardiac output between groups was 2.0 l/min after positioning for and the start of surgery and 1.5 l/min at the end of surgery (p < 0.05). Mean cardiac index reduced from baseline 3.9+/−0.8 to 2.6+/−0.7 and 2.4+/−0.6 (mean+/−SD l/min/m2) in groupJ and between groups: by 1.0 l/min/m2 after placement for, 1.1 at the start and 0.8 at the end of surgery (p < 0.05). Systemic vascular resistance increased from baseline 1080+/−338 to 1483+/−479 after placement for, 1523+/−481 at the start and 1525+/−545 at the end of surgery in groupJ (mean+/−SD dynes/sec/cm−5, p < 0.05).ConclusionsAccording to impedance cardiography, jack-knife position after low-dose spinal anaesthesia produces transitory, but statistically significant reduction of cardiac output and cardiac index with increase of systemic vascular resistance, compared to insignificant changes in lithotomy position.Trial registrationClinical Trials NCT02115178.

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Low-dose spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blinded, randomized, controlled study

Cited by 26 publications

References 36 publications

Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse

Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse

Effects of Adding Intrathecal Dexmedetomidine to Hyperbaric Bupivacaine for Saddle Spinal Block in Adults Undergoing Peri-anal Surgeries

Lithotomy versus jack-knife position on haemodynamic parameters assessed by impedance cardiography during anorectal surgery under low dose spinal anaesthesia: a randomized controlled trial

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