Combined spinal???epidural anesthesia and continuous spinal anesthesia

2011 ◽  
pp. 100-112
Author(s):  
M Silva Restrepo ◽  
S Halpern
Keyword(s):  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Continuous Spinal Anesthesia ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

scholarly journals Continuous Spinal Anesthesia versus Combined Spinal Epidural Anesthesia for Major Orthopedic Hip Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Abdelaziz ◽  
A N Elshaar ◽  
A E Elagamy ◽  
M A Ibrahim ◽  
M A Saleh
Keyword(s):  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Hip Replacement ◽  
Sensory Block ◽  
Continuous Spinal Anesthesia ◽  
Combined Spinal Epidural ◽  
Significant Difference ◽  
Post Operative Nausea ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background hip replacement surgery is common among elderly patients. These patients have increased risk for perioperative mortality and morbidity due to additional comorbidities, such as cardiac, endocrine, renal, cerebral and respiratory diseases. Aim of the Work to compare between continuous spinal anesthesia and combined spinal epidural anesthesia in patients scheduled for elective major hip surgeries as regards their effectiveness and possible complications during operation. Patients and Methods after obtaining the approval of the ethical committee of faculty of medicine, Ain-Shams University, and patients’ written informed consents, this prospective randomized clinical trial study was conducted at Ain Shams University Hospitals at the orthopedics operating theatre. Seventy two patients aged older than 30 years, of both sexes and American Society of Anesthesiologists (ASA) class I, II, scheduled for elective major hip surgeries like total hip replacement or hemi arthroplasty were included in the study. All Patients were assigned randomly by using a computer generated program with closed envelops to one of the two equal groups:CSAgroup(36)patient and CSEgroup(36)patient. Results there was no statistically significant differences between the CSA and CSE groups as regards demographic data; Age, Sex or BMI. Baseline HR was similar in both groups. The heart rate was significantly higher in the CSE group at 5 min and 15 min when compared to CSA group. The mean blood pressure was significantly lower in group CSE at 5min anf 15 min when compared to CSA group.The total dose of bupivacaine 0.5% mg collectively given was much lower in the CSA group than the CSE group. The onset of sensory block (time between the end of injection and the time to reach T10sesnsory level) and degree of motor block between two groups showed no statistically significant difference but the level of sensory block was significantly higher in CSE group than CSA group.there was no significant difference as regard PDPH, Post operative nausea and vomiting, Bradycardia but there was significant difference as regard incidence of hypotension being higher in CSE group than CSA group. The time of first analgesic request showed no significant difference between the two groups Conclusion both continuous spinal anesthesia and compined spinal epidural anesthesia are safe anesthetic techniques for lower limb surgeries. CSA offers possibilities of more hemodynamic stability with smaller doses of local anesthetics than CSE with rapid onset of sensory block and good extendede post operative analgesia.

scholarly journals Central Noninvasive Hemodynamics in Combined Spinal Epidural Anesthesia with Expansion of the Epidural Space in Obese Patients

2022 ◽  
Vol 18 (6) ◽  
pp. 90-96
Author(s):  
N. V. Davydov ◽  
I. G. Trukhanova ◽  
А. D. Gureev ◽  
Yu. G. Kutyreva
Keyword(s):  
Cardiac Output ◽  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Obese Patients ◽  
Hemodynamic Parameters ◽  
Combined Spinal Epidural ◽  
Group 2 ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Group 1

The objective: to substantiate the safety of using combined spinal epidural anesthesia with expansion of the epidural space in hernioplasty in obese patients.Subjects and Methods. Hemodynamic parameters were studied in 100 obese patients who underwent elective hernioplasty of the anterior abdominal wall using the neuroaxial block of two types ‒ combined spinal epidural anesthesia with epidural volume extension (CSEA with EVE) and spinal anesthesia (SA). The patients were randomly divided into two groups: Group 1 (n = 60) ‒ patients operated under combined spinal epidural anesthesia with the epidural volume extension, Group 2 (n = 40) ‒ patients operated under spinal anesthesia. The assessment of changes in main parameters of central hemodynamics, stroke volume (SV), cardiac output (CO), and cardiac index (CI) was performed using the Estimated Continuous Cardiac Output technology based on the measurement of pulse wave transit time.Results. It was revealed that in Group 1 patients, the listed parameters fluctuated slightly during the entire follow-up period. The average values were: SV 76.4 ± 0.37 ml, CO 5.8 ± 0.04 l/min, CI 3.56 ± 0.03 l/min/m2. In patients of Group 2, there was an increase in SV by 35.5%, CO by 24.2%, and CI by 23.6% at minutes 2-4 of the regional blockade.Conclusions. The most obvious fluctuations in hemodynamic parameters are observed in the group of patients who underwent spinal anesthesia using relatively high doses of local anesthetic. When using CSEA with EVE with low doses of bupivacaine, stable hemodynamic parameters are noted with a constant level of the neuroaxial block.

scholarly journals Combined Spinal Epidural Anesthesia for Total Hip Replacement Surgery in Birendra Army Hospital

2012 ◽  
Vol 10 (1) ◽  
pp. 32-36
Author(s):  
NB KC ◽  
S Rai ◽  
P Chand ◽  
A Joshi ◽  
BR Kunwar
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Hip Replacement ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Introduction: Total Hip Replacement surgery is one of the most commonly performed surgeries worldwide. Epidural anaesthesia have shown decrease incidence of DVT in these patient. Hence, combined spinal epidural spinal anesthesia is now a preferred technique over spinal anesthesia alone. We have been practicing combined spinal epidural anesthesia routienely in total joint replacement, but have not analyzed the result. The aim of this study was to analyse various aspect of combined spinal epidura anesthesia. Methods: thirteen cases of ASA I and II who underwent Total Hip Arthroplasty under combined spinal epidural anesthesia were analysed. First epidural was given in space L2-3/L3-4 and patency was confirmed with test dose with InjXylocaine 2% with Adrenaline 3 ml, followed by Spinal anesthesia one space below with Bupivacaine 0.5% 3 ml. Results: Intra operative Mean Blood Pressure had dropped up to 55 mm of Hg.To maintain Blood pressure, Intravenous Fluid was given in average is 2423.077 ml and Vasopressure drug (Mephenteramine Maleate) was given in average of14.769 mg. Dura was accidentally puncture in one patient during epidural insertion and two epidural failed to provide post operative analgesia. Post operative rehabilitation was easy, one one patient developed DVT after 4 weeks of surgery. Conclusion: Combined epidural analgesia effectively manages postoperative pain, allows early ambulation and reduces the risk of deep vein thrombosis and thromboembolism, Although significant drop of Blood pressure was noted in all cases. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6447 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 32-36

Combined Spinal-Epidural Anesthesia for Outpatient Surgery

1995 ◽  
Vol 83 (3) ◽  
pp. 528-534. ◽  
Author(s):  
William F. Urmey ◽  
Jennifer Stanton ◽  
Margaret Peterson ◽  
Nigel E. Sharrock
Keyword(s):  
Spinal Anesthesia ◽  
Epidural Anesthesia ◽  
Initial Dose ◽  
Knee Arthroscopy ◽  
Outpatient Surgery ◽  
Motor Blockade ◽  
Combined Spinal Epidural ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Prospective Study Design

Background Combined spinal-epidural anesthesia (CSE) may offer theoretic advantages for outpatient surgery, because it produces the rapid onset of spinal anesthesia, with the option to extend the blockade with an epidural catheter. In this study, the authors attempted to determine an appropriate initial dose of a short-acting local anesthetic, 2% lidocaine, to administer for outpatient knee arthroscopy using CSE. Methods Data were collected from 90 patients undergoing outpatient knee arthroscopy. Using a double-blinded, prospective study design, patients were randomly assigned to receive CSE with an initial dose of intrathecal 2% lidocaine of 40, 60, or 80 mg. A 27-G 4 11/16-inch Whitacre needle was placed through a 17-G Weiss needle. Onset and regression of sensory anesthesia and motor blockade were measured by a blinded observer at frequent intervals. Results All 90 patients had adequate anesthesia. Durations of thoracic and lumbar sensory and lower limb motor blockade were significantly shorter in the 40-mg group compared with the 60- or 80-mg groups (P < 0.0002 Mantel-Cox, Survivorship Analysis). Indices of neural blockade resolved 30-40 min more rapidly in the 40-mg group than in either the 60- or 80-mg group. Times to urinate, site upright in a chair, take oral fluids, and be discharged were all significantly shorter (between 30 and 60 min) in the 40-mg group compared with the 60- and 80-mg groups (P < 0.01). Seven patients required intraoperative epidural supplementation: three in the 40-mg group, three in the 60-mg group, and one in the 80-mg group. Conclusions Combined spinal-epidural anesthesia with a 40-mg initial intrathecal dose of lidocaine provided reliable anesthesia for knee arthroscopy. Duration of spinal anesthesia with lidocaine was dose related.

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