scholarly journals A Prospective Randomised Trial Comparing Spinal Anaesthesia using Hyperbaric Cinchocaine with General Anaesthesia for Lower Limb Vascular Surgery

1986 ◽  
Vol 14 (4) ◽  
pp. 373-380 ◽  
Author(s):  
P. T. Cook ◽  
M. J. davies ◽  
K. D. Cronin ◽  
P. Moran
Keyword(s):  
Vascular Surgery ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Myocardial Infarct ◽  
Randomised Trial ◽  
Limb Amputation ◽  
Significant Difference ◽  
Spinal Group ◽  
General Anaesthesia Group

One hundred and one patients were randomly allocated to have their peripheral vascular surgery performed under general anaesthesia (51 patients) or spinal anaesthesia (50 patients). Intraoperative haemodynamic changes were markedly different between the two groups with a higher incidence of hypotension in the spinal group (72% vs 31%) and a higher incidence of hypertension in the general anaesthesia group (22% vs 0%). Blood loss was significantly less in the spinal group (560, SD 340, ml vs 792, SD 440, ml). Postoperatively three patients from the general anaesthesia group died from causes unrelated to the anaesthesia, and one had a myocardial infarct. Two patients in the spinal group had myocardial infarcts, both had been treated for bradycardia and hypotension intraoperatively, and one died. There was a significantly higher incidence of postoperative chest infection in the general anaesthesia group (33% vs 16%). There was no significant difference between the groups in the incidence of postoperative confusion, or lower limb amputation rate or need for further surgery prior to hospital discharge.

Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

2006 ◽  
Vol 30 (2) ◽  
pp. 155-164 ◽  
Author(s):  
Ji Cheol Shin ◽  
Eun Joo Kim ◽  
Chang Il Park ◽  
Eun Sook Park ◽  
Kyoo-Ho Shin
Keyword(s):  
Clinical Features ◽  
Lower Limb ◽  
Daily Living ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Medical Problems ◽  
Amputation Level ◽  
Significant Difference ◽  
Bilateral Lower Limb ◽  
Lower Limb Amputees

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation ( p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators ( p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores ( r = −0.518 vs. r = −0.550) ( p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.

scholarly journals Avaliação postural de sujeitos com amputação de membro inferior

2019 ◽  
Vol 29 (1) ◽  
pp. 33103
Author(s):  
Viviane Leite ◽  
Lisiane Piazza Luza ◽  
Sara Maria Soffiatti Dias ◽  
Thamara Caviquioni ◽  
Ediane Roberge Fernandes Zampirolo ◽  
...  
Keyword(s):  
Lower Limb ◽  
T Test ◽  
Limb Amputation ◽  
Postural Asymmetry ◽  
Significance Level ◽  
Below The Knee ◽  
Significant Difference ◽  
Ankle Angle ◽  
The Right ◽  
Left Scapula

AIMS: To evaluate the posture of subjects with lower limb amputee.METHODS: Ten subjects participated in the study, males, with 38,2 ± 8,2 years, with unilateral lower limb amputation and prosthesis users. For the postural evaluation, the Postural Evaluation Software (SAPO) was used, and the images were evaluated according to the software protocol. Data were analyzed through descriptive and inferential statistics (independent t test), with a significance level of p ≤ 0,05.RESULTS: The main alterations observed were: rearfoot valgus enlargement, flexed ankle, head tilted to the right and trunk in flexion. When compared the posture according to time of amputation, was observed a statistically significant difference in the horizontal asymmetry of scapula in relation to T3 (p = 0,004), being that subjects with amputation time of up to six years presented the left scapula higher than the right one (-5,28 ± 8,16°) and those with more than six years of amputation had the right upper right scapula (19,42 ± 11°). In the comparison between amputation levels, there was a statistically significant difference in the ankle angle (p = 0,008), with subjects with amputation below the knee presenting greater ankle flexion (81,97 ± 1,72°) than those with amputation at the level of the knee and above this (87,30 ± 2,65°).CONCLUSIONS: The findings of the present study demonstrate that all the evaluated subjects presented some postural alteration, however, it cannot be affirmed that the postural asymmetry of these is due to the amputation.

scholarly journals Sciatic obturator femoral technique versus spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. A randomised trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hoda Shokri ◽  
Amr A. Kasem
Keyword(s):  
Adverse Events ◽  
Spinal Anaesthesia ◽  
External Fixator ◽  
Randomised Trial ◽  
Study Groups ◽  
Tibial Fractures ◽  
Hyperbaric Bupivacaine ◽  
Ilizarov External Fixator ◽  
Open Tibial Fractures ◽  
Significant Difference

Abstract Background Peripheral nerve block is preferable for lower extremity surgery because it sufficiently blocks pain pathways at different levels providing excellent anaesthesia at the site of surgery. We designed this study to compare the efficacy and safety of SOFT block (sciatic-obturator-femoral technique) compared with spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. Methods One hundred and seven patients ASA I, II scheduled for fixation of open tibial fractures using Ilizarov external fixator. The patients were randomly allocated to receive either spinal anaesthesia or SOFT block. In spinal anaesthesia group, patients received spinal anaesthesia with hyperbaric bupivacaine 0.5% (7. 5-10mg). In SOFT group, patients received SOFT block with bupivacaine 0.25%. Primary endpoint included the duration of analgesia. The secondary endpoints included patient satisfaction scores, visual analogue scores, incidence of adverse events as vomiting, systemic toxicity from local anaesthetic drug and time to first effect of the techniques. Results The duration of SOFT block and time to first analgesic dose in SOFT group was significantly longer (p < 0.001). There was no significant difference between the study groups regarding satisfaction scores, the incidence of cardiovascular collapse, seizures and paraesthesia. Pain scores were significantly lower in SOFT group at 3,6,12 h postoperative (p < 0.001). The time to the first effect was significantly longer in SOFT group (p < 0.001). Conclusion SOFT is a feasible technique of local anaesthesia for control of postoperative pain with unremarkable adverse events compared with spinal anaesthesia, in patients undergoing fixation of tibial fractures using Ilizarov external fixator. Trial registration This trial was retrospectively registered at ClinicalTrials.gov. registry number: NCT03450798 on February 20, 2018.

Single-dose spinal anaesthesia versus incremental dosing for lower limb vascular surgery

1999 ◽  
Vol 43 (4) ◽  
pp. 405-410 ◽  
Author(s):  
L. Lundorff ◽  
J. O. Dich-Nielsen ◽  
H. Laugesen ◽  
M. M. Jensen
Keyword(s):  
Single Dose ◽  
Vascular Surgery ◽  
Spinal Anaesthesia ◽  
Lower Limb

Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation

The Lancet ◽  
1997 ◽  
Vol 350 (9088) ◽  
pp. 1353-1357 ◽  
Author(s):  
Lone Nikolajsen ◽  
Susanne Ilkjaer ◽  
Jørgen H Christensen ◽  
Karsten Krøner ◽  
Troels S Jensen
Keyword(s):  
Lower Limb ◽  
Randomised Trial ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Phantom Pain ◽  
Epidural Bupivacaine

scholarly journals Research priorities for lower limb amputation in patients with vascular disease

2021 ◽  
Author(s):  
David Bosanquet ◽  
Sandip Nandhra ◽  
Kitty Wong ◽  
Judith Long ◽  
Ian Chetter ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Lower Limb ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Lower Limb Amputation ◽  
Nominal Group ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Specific Research ◽  
Research Questions

Introduction Lower limb amputation is a life-changing event for patients and can be associated with high mortality and morbidity rates. Research into this critical part of vascular surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) process, aimed to identify and develop key research priorities for amputation. Methods A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research topics were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then ranked by the same participants and amalgamated to produce a list for final prioritisation. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with amputation. Using a nominal group technique, the top ten research priorities were identified. Results A total of 481 clinicians submitted 1231 research questions relating to vascular surgery in general. 63 amputation-specific research questions were combined into 5 final clinical questions. 373 patients or carers submitted 582 research questions related to vascular surgery in general. Nine amputation-specific research questions were identified after combining similar questions. Amalgamating both the clinician and patient questions, 12 questions were discussed at the final prioritisation meeting and the top 10 identified. These related to amputation prevention, supporting rehabilitation, improving clinical outcomes following amputation (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing amputation. Conclusion The top 10 research priority areas in vascular amputation provide guidance for researchers, clinicians, and funders on the direction of future research questions that are important to both healthcare professionals and patients.

scholarly journals Comparing the Effects of Pre-loading with Gelatine 4% Plasma Volume Expander and 6% Hydroxyethyl Starch Solution Before Spinal Anaesthesia for Lower Limb Orthopaedic Surgery

2020 ◽  
Vol 27 (6) ◽  
pp. 68-78
Author(s):  
Nur Dyana Md Nizar ◽  
Shamsul Kamalrujan Hassan ◽  
Rhendra Hardy Mohamad Zaini ◽  
Mohamad Hasyizan Hassan ◽  
Wan Mohd Nazaruddin Wan Hassan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Anaesthesia ◽  
Lower Limb ◽  
Orthopaedic Surgery ◽  
Venous Blood ◽  
Acid Base Balance ◽  
Acid Base ◽  
Significant Difference ◽  
Lower Limb Surgery ◽  
Base Balance

Background: Hypotension is a common complication following spinal anaesthesia. The administration of intravenous fluids prior to spinal anaesthesia, known as pre-loading, has been used to offset the hypotension effect; however, the ideal fluid for pre-loading is still a matter of debate. The objective of this study was to compare the effects of Gelaspan 4% and Volulyte 6% as pre-loading fluids. Methods: A total of 93 patients with American Society of Anaesthesiologists (ASA) physical status I or II having lower limb orthopaedic surgery under spinal anaesthesia were randomised into two groups that received either Volulyte (n = 47) or Gelaspan (n = 46). Before the spinal anaesthesia, these patients were pre-loaded with 500 mL of the fluid of their respective group. Blood samples were taken before pre-loading and again after spinal anaesthesia and sent for venous blood gas and electrolyte level measurement. Baseline and intraoperative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and the requirement of ephedrine to treat hypotension were also recorded. Results: Both fluids could not prevent significant reductions in SBP (P = 0.011), DBP (P = 0.002) and MAP (P = 0.001). There was also significant reduction in HR over time (P < 0.001). There was no significant difference in terms of ephedrine usage between both groups. Neither Volulyte 6% nor Gelaspan 4% caused significant changes in acid-base status. Conclusion: The use of 500 mL of either Gelaspan 4% or Volulyte 6% as pre-loading fluids did not significantly prevent the incidence of post-spinal anaesthesia hypotension following orthopaedic lower limb surgery; however, both were useful in the maintenance normal acid-base balance.

Compare the Analgesic Efficacy of Dexmedetomidineand Fentanyl as an Adjuvant to Bupivacaine for Lower Limb Surgery

2021 ◽  
Vol 15 (6) ◽  
pp. 2153-2155
Author(s):  
Arshi Naz ◽  
Mirza Shahzad Baig ◽  
Vijai Kumar ◽  
Samita S Khan ◽  
Sidra Javed ◽  
...  
Keyword(s):  
Spinal Anaesthesia ◽  
Lower Limb ◽  
P Value ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia ◽  
Sensory Blockade ◽  
Significant Difference ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B

Objective: To compare the analgesic effectiveness of Dexmedetomidine and Fentanyl as an adjuvant to 0.5% Bupivacaine in spinal anaesthesia for patients undergoing lower limb surgery. Study Design: Randomized controlled trial. Place & Duration:The study was conducted at department of Anesthesia, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi for duration from 15thJuly2020 to 15thFebruary 2021. Methods: In this study 52 patients of both genders undergoing lower limb surgeries were included. Patient’s ages were ranging from 20 to 70 years. All the patients were divided into two Groups. Group A included 26 patients and received Inj. Dexmedetomidine 10 μg in 0.5ml normal saline with 12.5mg of 0.5% hyperbaric bupivacaine, Group B had 26 patients and received 25mg fentanyl with 12.5mg of 0.5% hyperbaric bupivacaine. Time to achieve T10 blockade, time to first rescue analgesia were examined and compare between both groups. All the statistical data was analyzed by SPSS 24.0. P-Value <0.05 was significantly considered. Results: Mean age of group A was 40.52±12.28 years and in group B it was 40.14±13.34 years. There were 18 (69.23%) male patients and 8 (30.77%) females in group A while in Group B 19 (73.08%) patients were male and 7 (26.92%) were females. No significant difference was observed between both groups regarding time to T10 blockade with p-value >0.05. A significant difference was found regarding time to rescue analgesia, in Group A it was 426.58±92.44 minutes and in Group B, it was 206.44±48.47 minutes (p-value <0.0001). Patients’ satisfaction was high in dexemedetomidine group as compared to fentanyl group. Conclusion: Dexmedetomidine 10 μg with 0.5% bupvicaine showed better effectiveness regarding time to first rescue analgesia as compared to fentanyl. No significant difference was observed regarding time to sensory blockade between both medications. Keywords: Dexmedetomidine, Fentanyl, Spinal Anaesthesia, Lower Limb Surgery, Sensory Block, Analgesia

scholarly journals Differences in characteristics between people with lower limb amputations who died before 12 weeks and those who survived: Short Report

2011 ◽  
Vol 67 (1) ◽  
Author(s):  
L. Godlwana ◽  
A. Stewart ◽  
E. Musenge
Keyword(s):  
Lower Limb ◽  
Limb Amputation ◽  
Short Report ◽  
Test Study ◽  
Demographic Questionnaire ◽  
Significant Difference ◽  
Post Test ◽  
Status Index ◽  
Ethical Clearance

The baseline determinants of survival following a non-traumatic lower limb amputation (LLA) in participants in the Johannesburg metropolitan area are unknown.The aim of the study was to establish the characteristics of participants who had died by three months after LLAA longitudinal pre- test- post test study utilized participant interviews (n=73).  Consecutive  sampling  was  used  to  select  participants  who  met  the  inclusion criteria. Ethical clearance was obtained. Permission was obtained from the hospitals. Participants gave consent before taking part in the study. A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI) and the Barthel Index (BI) were used, to collect data. Participants  were  interviewed  preoperatively  and  then  followed  up  three  months  post-operatively  to  establish survival/ existence. Twenty-four  participants  (33%)  had  died.  The  preoperative  median  Visual  Analogue  Scale  (VAS)  of  the  EQ-5D was 60 and 70 showing no significant difference in quality of life (QOL) between those who survived and those who  died  respectively.  The  preoperative  median  total  BI  score  was  20  and  19  showing  significantly  inferior  function for the deceased (p=0.01). The deceased were significantly older (p=0.009) used alcohol (p=0.02) and smoked tobacco (p=0.03).Being older, having poorer function, being a smoker and drinking alcohol preoperatively seem to decrease the chance of survival following LLA in Johannesburg.

Sign in / Sign up

Export Citation Format

Share Document