Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries

Elfeky, Mohamad A; Stohy, Al Sayed M; Sabra, Mostafa M; Mahareak, Ali A; Alkumity, Ali A

doi:10.4103/roaic.roaic_75_18

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…Hypotension was defined as a 20% In a study of 100 high risk patients undergoing major orthopedic surgeries, where patients were divided into 2 groups; CSA group and continuous epidural anesthesia (CEA) group; the maximum decrease in MAP was more severe in CEA group and the difference was statistically significant. The number of patients treated for hypotension and total dose of ephedrine was more in CEA, though it was not statistically different (6).…”

Section: Discussionmentioning

confidence: 74%

Hemodynamic Effects of Continuous Versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Ahmad

El-Zahaby

Mady

et al. 2023

Benha Medical Journal

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Background: Continuous Spinal Anesthesia (CSA) is an underused regional anesthesia technique. But with the increased Geriatric population presenting to surgeries, CSA with its relative hemodynamic stability is coming back to anesthetists' interests. Better control of hemodynamics is advantageous in elderly patients and those with cardiac diseases. Objective: To compare the incidence of hypotension in continuous spinal anesthesia CSA versus single dose spinal anesthesia SDA in octogenarians undergoing hip surgery, the total use of Ephedrine and the incidence of spinal complications. Methods: Forty (40) patients were enrolled in the study and allocated into two groups 20 patients in continuous spinal anaesthesia group (CSA) and 20 patients in single dose anaesthesia group (SDA). Results: CSA has less effect on hemodynamics in elderly patients with fewer complications. There was a statistically significant difference in MAP between CSA group and SDA group between min 5 & min 40 with p-value <0.001. Satisfactory anesthesia was obtained using CSA, with significantly less dose of bupivacaine (SDA group (12.5±0.8 mg) vs. in CSA group (7.6±1.3 mg), p-value <0.001). And less doses of ephedrine were needed (4.5±1.7 mg in CSA group vs. 19.5±11.3 mg in SDA group, pvalue 0.006). Conclusion: CSA is a safe and effective technique in minimizing the hemodynamic instability, lowering the total vasopressor need and reducing local anesthetic dose, subsequently lowering spinal anesthesia complications. CSA is better to be used in octogenarian patients with pre existing risk factors undergoing hip surgeries.

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Section: Discussionmentioning

confidence: 74%

Hemodynamic Effects of Continuous Versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Ahmad

El-Zahaby

Mady

et al. 2023

Benha Medical Journal

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“…It offers a rapid onset of action, provides reliable surgical anesthesia, good muscle relaxation, requires a small amount of anesthetic agent, and is comparatively simple to perform. When performed under epidural anesthesia, there are fewer incidences of cardiovascular instability and post-dural puncture headaches compared to spinal anesthesia, and it works well for longer surgical procedures [ 7 ]. CSEA has the advantage of attenuating the neurohumoral stress response to surgery, producing vasodilatation thereby reducing afterload, reducing the incidence of a thromboembolic phenomenon, avoiding polypharmacy, and enhancing early ambulation [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Spinal, Epidural, and Sequential Combined Spinal Epidural Anesthesia in Geriatric Patients for Transurethral Resection of the Prostate

Tomar,

Yadav,

Singh

et al. 2024

Cureus

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Background: Sequential combined spinal epidural anesthesia (CSEA) is probably the greatest advancement in the central neuraxial block in this decade for geriatric patients due to the potential advantages of both spinal and epidural anesthesia. This study was designed to compare the clinical effects of sequential CSEA versus spinal and epidural anesthesia in geriatric patients undergoing transurethral resection of the prostate (TURP). Methods: Ninety patients aged 65 to 80 years were randomly allocated into three groups of 30 each. Group A (n=30) patients were administered spinal anesthesia with 2.5 ml of 0.5% hyperbaric bupivacaine, group B (n=30) received epidural anesthesia with 15 ml of 0.5% isobaric bupivacaine, and group C (n=30) received sequential CSEA with 1 ml of 0.5% hyperbaric bupivacaine and 6 ml of 0.5% isobaric bupivacaine given through epidural route to extend the block up to T10. Patients were observed for hemodynamic parameters, sensory and motor block, total dose required to establish the desired level, and patient satisfaction score. Results: None of the patients were excluded in the study. Group A patients reported rapid onset of sensory block (3.08±11.57 minutes) compared to group B (11.57±1.48 minutes), and group C (5.47±1.25 minutes). The onset of motor block was expeditious in group A (8.08±1.0 minutes) compared to group B (20.33±1.86 minutes) and group C (15.53±1.31 minutes). Patients in group B had maximum hemodynamic stability but with delayed onset and were technically more complex than group A. Patients in group C were hemodynamically more stable than group A. They had a faster onset of action with decreased doses of local anesthetic drug required compared to group B. Conclusion: Sequential CSEA is a safe, effective, and reliable technique that combines the advantages of both spinal and epidural while minimizing their disadvantages. It has the advantage of stable hemodynamic parameters along with the provision of prolongation analgesia for geriatric patients undergoing TURP surgery.

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Comparison of Block Characteristics in Continuous Spinal Anesthesia and Continuous Epidural Anesthesia for Lower Limb Orthopedic Surgeries

Vipul

Shah

et al. 2022

Journal of Indian College of Anaesthesiologists

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Background: Continuous epidural anesthesia (CEA) is commonly used in routine practice even though it needs a higher dose of local anesthetics (LA) and is sometimes associated with a patchy or unilateral block. Despite advantages, continuous spinal anesthesia (CSA) is underutilized because of concern related to infection and postdural puncture headache. Our aim was to compare the block characteristics and hemodynamic changes following CSA and CEA in lower limb orthopedic surgeries. Materials and Methods: After approval from the Institutional Scientific and Ethics Committee and Registration with (Clinical Trials Registry of India/2021/02/031575), a prospective, double-blind, randomized study was conducted in 144 patients, American Society of Anesthesiologists I-II, aged 18–65 years, scheduled for lower limb orthopedic surgeries. Patients were randomly divided into two groups according to anesthesia technique used (n = 72), i.e., Group CSA and Group CEA. Block characteristics, hemodynamic variables, intraoperative LA requirement, and complications were recorded. Results: Demographic and surgical data, grade of sensory and motor blockade, and incidence of complications were comparable in both the groups. Induction time was significantly shorter in CSA (8.14 ± 0.88 min vs. 15.75 ± 3.29 min, P < 0.0001). Performance time (5.31 ± 0.92 min vs. 4.92 ± 1 min; P = 0.008), duration of blockade (68.3 ± 4.23 min vs. 65.54 ± 4 min; P < 0.0001), and analgesia (230.48 ± 40.76 min vs. 222.86 ± 39.79 min; P = 0.024) were significantly longer in CSA. A significant fall in diastolic blood pressure and mean arterial pressure occurred in CEA. LA requirement was significantly lower in CSA (11.62 ± 2.5 mg vs. 65.35 ± 7.71 mg; P < 0.00001). Conclusions: Considering shorter induction time, prolonged sensory blockade, and analgesia with greater hemodynamic stability, CSA could be preferred over CEA for lower limb orthopedic surgeries.

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Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries

Cited by 3 publications

References 3 publications

Hemodynamic Effects of Continuous Versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Hemodynamic Effects of Continuous Versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Comparative Study of Spinal, Epidural, and Sequential Combined Spinal Epidural Anesthesia in Geriatric Patients for Transurethral Resection of the Prostate

Comparison of Block Characteristics in Continuous Spinal Anesthesia and Continuous Epidural Anesthesia for Lower Limb Orthopedic Surgeries

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