scholarly journals Low dose spinal anesthesia for open cholecystectomy: a feasibility and safety study

2017 ◽  
Vol 4 (4) ◽  
pp. 1417
Author(s):  
Jaouad Laoutid ◽  
Fouad Sakit ◽  
Nabil Jbili ◽  
Moulay Ahmed Hachimi
Keyword(s):  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Open Cholecystectomy ◽  
Hyperbaric Bupivacaine ◽  
Patient Satisfaction Scores ◽  
Experienced Pain ◽  
Anaesthetic Procedure ◽  
Oblique Incision ◽  
Operative Difficulty

Background: Cholecystectomy is performed either open or a laparascopic route. the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Spinal anesthesia (SA) has been widely used as alternative to General Anesthesia (GA) for laparoscopic cholecystectomy. SA could be a safe and effective anaesthetic procedure for open cholecystectomy.  This study was conducted to uncover feasibility and safety of low dose SA for conducting open cholecystectomy.Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy received SA using 2 ml of 0.5% hyperbaric Bupivacaine mixed with 100 µg Morphine. Peri-operative preparations and management were all standardized. Other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. Open cholecystectomy by right oblique incision. Intra-operative events and post-operative events were observed for 48 hours, operative difficulty, post operative pain free interval, analgesia requirements, hospital stay and the surgeon and patient satisfaction were studied.Results: 20 patients were included in the study from 1st may 2016 to December 2016. Spinal anesthesia was adequate for surgery in all patients. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Intraoperatively, five patients presented hypotension and Ephedrine was given. Four patients experienced pain and received Fentanyl and midazolam. Postoperatively, pain scores were minimal and paracetamol was not sufficient only in four patients who received ketoprofen and no patient received opioid. One patient required antiemetic for vomiting and two patients suffered urinary retention and one headache. 19 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good.Conclusions: Spinal anesthesia is safe and effective anesthetic technic for uncomplicated open cholecystectomy in terms of peri-operative events and, in prolonged post-operative analgesia, as well as in terms of patient and surgeon’s satisfaction.

scholarly journals Spinal anaesthesia for laparoscopic cholecystectomy: A feasibility and safety study

1970 ◽  
Vol 7 (4) ◽  
pp. 360-368 ◽  
Author(s):  
B Gautam
Keyword(s):  
Patient Satisfaction ◽  
Laparoscopic Cholecystectomy ◽  
Spinal Anaesthesia ◽  
Intrathecal Morphine ◽  
Open Cholecystectomy ◽  
Abdominal Pressure ◽  
Operating Table ◽  
Opioid Use ◽  
Hyperbaric Bupivacaine ◽  
Operative Difficulty

Background: Regional anaesthetic techniques have benefited those patients undergoing laparoscopic surgeries that are deemed high risk to receive general anaesthesia (GA). But spinal anaesthesia (SA) has not been routinely employed as the sole technique for laparoscopic cholecystectomy (LC). Objective: This study was conducted to uncover feasibility and safety of SA for conducting LC. Materials and methods: Twelve American Society of Anaesthesiologists' physical status I or II patients undergoing elective LC received SA using 4 ml of 0.5% hyperbaric Bupivacaine mixed with 0.15 mg Morphine. Peri-operative preparations and management were all standardised, with other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. LC was performed with CO2 pneumoperitoneum maintained at an intra-abdominal pressure of less than 10 mm Hg and with minimal operating table tilt. Peri-operative events, operative difficulty, hospital stay and patient satisfaction were studied. Results: Spinal anaesthesia was adequate for surgery in all but one patient. Intraoperatively, two out of four patients who experienced right shoulder pain received Fentanyl. Two patients were given Midazolam for anxiety and one was given Ephedrine for hypotension. Operative difficulty scores were minimal and surgery in one patient was converted to open cholecystectomy. Postoperatively, pain scores were minimal and no patient demanded opioid. One patient required antiemetic for vomiting and one patient each suffered headache and urinary retention. 11 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good. Conclusion: Spinal anaesthesia with Morphine-mixed hyperbaric Bupivacaine is adequate and safe for elective LC in otherwise healthy patients and minimises postoperative pain and opioid use. Success and safety of this technique, however, necessitates knowledgeable patient, gentle surgical procedure, and co-operation among patient and members of the perioperative care team. Key words: Hyperbaric Bupivacaine; intrathecal Morphine; laparoscopic cholecystectomy; spinal anaesthesia. DOI: 10.3126/kumj.v7i4.2755 Kathmandu University Medical Journal (2009) Vol.7, No.4 Issue 28, 360-368

scholarly journals Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial

2016 ◽  
Vol 66 (6) ◽  
pp. 622-627 ◽  
Author(s):  
Alexandre Dubeux Dourado ◽  
Ruy Leite de Melo Lins Filho ◽  
Raphaella Amanda Maria Leite Fernandes ◽  
Marcelo Cavalcanti de Sá Gondim ◽  
Emmanuel Victor Magalhães Nogueira
Keyword(s):  
Clinical Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Randomized Clinical Trial ◽  
Low Dose ◽  
Hyperbaric Bupivacaine

Low-Dose Spinal Anesthesia with Hyperbaric Bupivacaine with Intrathecal Fentanyl for Operative Hysteroscopy: A Case Series Study

2012 ◽  
Vol 19 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Pasquale Florio ◽  
Rosa Puzzutiello ◽  
Marco Filippeschi ◽  
Pasquale D’Onofrio ◽  
Liliana Mereu ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Low Dose ◽  
Case Series ◽  
Hyperbaric Bupivacaine ◽  
Operative Hysteroscopy ◽  
Case Series Study ◽  
Series Study

scholarly journals PERIOPERATIVE EFFECTS OF INTRATHECAL CLONIDINE AND FENTANYL WITH HYPERBARIC BUPIVACAINE IN SPINAL ANESTHESIA FOR VAGINAL HYSTERECTOMY

2016 ◽  
Vol 9 (5) ◽  
pp. 245
Author(s):  
Suman Chattopadhyay ◽  
Mallika Datta ◽  
Biswanath Biswas
Keyword(s):  
Placebo Group ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Mechanisms Of Action ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Prolonged Duration ◽  
Group A ◽  
Group B ◽  
Intrathecal Clonidine

ABSTRACTObjectives: Intrathecal fentanyl and clonidine are effective analgesics with different mechanisms of action. This study compares 25 µg of both thesedrugs given intrathecally regarding onset, quality, and duration of hyperbaric bupivacaine-induced spinal block and side effects.Methods: A total of 90 patients of ASA I and II were randomly allocated into three equal groups. Group A received 0.5 ml of 0.9% normal saline(placebo), Group B and Group C received 25 µg fentanyl and clonidine intrathecally added to 2.5 ml of 0.5% hyperbaric bupivacaine, respectively. Theonset and regression time of sensory and motor blocks were recorded along with hemodynamic change, side effects, pain intensity (in terms of visualanalog score (VAS), and time to first rescue analgesic.Results: Intrathecal clonidine (25 μg) significantly prolongs sensory and motor blocks, with prolonged duration of analgesia in comparison withintrathecal fentanyl (25 µg) (325±15 minutes vs. 240±7.6 minutes). VAS score was similar, but sedation was more in clonidine group.Conclusion: We conclude that low-dose intrathecal clonidine is an effective adjuvant to bupivacaine for spinal anesthesia and provides betterpostoperative analgesia in comparison with intrathecal fentanyl.Keywords: Clonidine, Fentanyl, Bupivacaine, Regional, Spinal, Postoperative pain.

scholarly journals Muscle-splitting mini-incision cholecystectomy under spinal anesthesia: cost-effective equitable minimally invasive surgery in laparoscopy era

2021 ◽  
Vol 24 (1) ◽  
pp. 2-9
Author(s):  
Jay Shah ◽  
Ram Dayal Mandal ◽  
Jenifei Shah ◽  
Jesifei Shah
Keyword(s):  
Patient Satisfaction ◽  
Bile Duct ◽  
Spinal Anesthesia ◽  
Open Cholecystectomy ◽  
Cost Effective ◽  
Wound Complications ◽  
Oral Liquid ◽  
Ethical Approval ◽  
Hospital Stays ◽  
Mini Incision

Introduction: Conventional open cholecystectomy has been increasingly replaced by laparoscopy which requires resources for expensive equipment, training, and maintenance. Muscle-splitting mini-incision cholecystectomy under spinal anesthesia has comparable outcomes to laparoscopy and requires fewer resources. This study analyzes the feasibility and outcome of muscle-splitting mini-incision cholecystectomy under spinal anesthesia. Methods: All consecutive cases of muscle-splitting mini-incision cholecystectomy (MC) performed for symptomatic cholelithiasis during three years ending in December 2019, at a periphery hospital in Janakpur, province-2, Nepal, were included. Complicated cholelithiasis (biliary pancreatitis, jaundice, cholangitis, dilated common bile duct) was excluded. Written informed consents were obtained. The need for general anesthesia, complications during and after surgery, and patient satisfaction were analyzed descriptively. Ethical approval was obtained. Results: Out of 148 MC completed under spinal anesthesia, six (4.1%) required fentanyl for shoulder discomfort. Mild post-operative pain was reported by 124 (83.8%) at six hours and 146 (98.6%) at 12 hours. The intravenous drip was stopped after surgery and oral liquid with analgesics started in two hours in 143 patients (96.6%). Post-operative antibiotic was given in nine, for 2(1.4%) cholecysto-duodenal fistulas, 4(2.7%) diabetics, and 3(2%) mucoceles. The mean hospital stay was one night. Wound complications occurred in 6(2.8%). Overall, 144 (97.3%) were satisfied and would recommend the procedure to others. Histopathology revealed adenocarcinoma in one case. There was no bile-duct injury, re-surgery, or mortality. Conclusion: Muscle-splitting mini-incision open cholecystectomy (MC) under spinal anesthesia is safe and effective with early feeding, short hospital stays, less demand for resources, and good patient satisfaction.

scholarly journals Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease

2019 ◽  
Author(s):  
Isngadi Isngadi ◽  
Rudi Hartono ◽  
Dewi Puspitorini Husodo ◽  
Eka Sunarwidhi Prasedya
Keyword(s):  
Heart Disease ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Low Dose ◽  
Fetal Outcome ◽  
Post Injection ◽  
Physiological Changes ◽  
Hyperbaric Bupivacaine ◽  
Metabolic System

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 μg fentanyl for caesarean section in patient with heart disease.Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 μg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician.Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation.Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 μg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.Citation: Husodo DP, Isngadi I, Hartono R, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesth pain & intensive care 2019;23(3):274-278

scholarly journals Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

2019 ◽  
Vol 9 (2) ◽  
pp. 79-82
Author(s):  
Bharati Devi Sharma Regmi ◽  
Gopendra Prasad Deo ◽  
Subin Shrestha ◽  
Sabita Shrestha ◽  
Renuka Tamrakar Mishra
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Elective Cesarean

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group. Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

scholarly journals Comparison between high dose hyperbaric Bupivacaine (12.5 mg) alone versus low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in spinal anaesthesia for inguinal hernia surgery

2016 ◽  
Vol 3 (3) ◽  
pp. 140 ◽  
Author(s):  
Manish B. Kotwani ◽  
Kanchan Rupwate ◽  
Prashanth Shivananda ◽  
Jyoti Magar
Keyword(s):  
Inguinal Hernia ◽  
Side Effects ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Opioid Analgesic ◽  
High Dose ◽  
Motor Blockade ◽  
Hyperbaric Bupivacaine ◽  
Inguinal Hernia Surgery ◽  
Group B

<p class="abstract"><strong>Background:</strong> For performing inguinal hernia surgeries, giving spinal anesthesia is a well known technique as it easy and provides fast onset, effective sensory and motor blockade in an awake patient. Now-a-days Bupivacaine is gaining importance as an effective spinal anaesthetic agent in combination with opioid analgesic Fentanyl to reduce the postoperative pain and side effects associated with surgery. This study aims to compare the effectiveness of intrathecal Bupivacaine alone versus combination of Bupivacaine with Fentanyl.</p><p class="abstract"><strong>Methods:</strong> The study designed was a prospective, randomized, double blinded comparative study. Patients were randomly divided into two groups of 25 each. Group B received hyperbaric intrathecal Bupivacaine 12.5 mg and Group BF received diluted hyperbaric intrathecal Bupivacaine 7.5 mg and Fentanyl 25 µg for spinal anesthesia . Parameters like sensory and motor block were assessed. Side effects produced during perioperative and postoperative period were observed and noted. Satisfactory criteria by the surgeons and patients were considered.</p><p class="abstract"><strong>Results:</strong> The time taken to attain surgical anesthesia and peak sensory levels in minutes was statistically significant in Group B compared to Group BF. Due to higher dose of Bupivacaine, it was observed that degree of motor blockade is also higher in group B when compared to group BF. The incidence of hypotension, nausea, vomiting and hypothermia are significantly higher in group B due to high dose of Bupivacaine. The surgeons and patients satisfaction was good in both the groups.  </p><p><strong>Conclusions:</strong> Low dose Bupivacaine in combination with Fentanyl is safe and effective alternative for spinal anesthesia for inguinal herniorrphaphy as compared to conventional high dose Bupivacaine alone.</p>

scholarly journals Low-dose Bupivacaine with Dexmedetomidine Prevents Hypotension After Spinal Anesthesia

2015 ◽  
Vol 9 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Young Seop Chang ◽  
Ji-Eun Kim ◽  
Tae-Yun Sung
Keyword(s):  
Spinal Anesthesia ◽  
Orthopedic Surgery ◽  
Low Dose ◽  
Saline Group ◽  
Loading Dose ◽  
Hyperbaric Bupivacaine ◽  
Group B

Background: We assessed whether intrathecal low-dose bupivacaine with dexmedetomidine could reduce the incidence of spinal anesthesia (SA)-related hypotension. Methods: In total, 47 patients undergoing urological or orthopedic surgery under SA were randomized into two groups. SA was induced using 12.5 mg of hyperbaric bupivacaine alone (Group B; n = 24 patients) or 6 mg of hyperbaric bupivacaine plus 4 μg of dexmedetomidine and 0.3 ml of saline (Group BD; n = 23 patients). At 10 min after SA, dexmedetomidine was infused in both groups at a loading dose of 0.5 µg/kg, administered over 10 min, and then maintained at a dose of 0.2 µg/kg/h for 40 min. Results: The incidence of hypotension was significantly higher in Group B than in Group BD (50.0 vs. 17.4%, P = 0.018). The amount of ephedrine used to treat hypotension was significantly higher in Group B than in Group BD (median [range], 3 [0–30] vs. 0 [0–12] mg, P = 0.014). Conclusion: Low-dose bupivacaine plus dexmedetomidine SA reduced the incidence of hypotension compared to conventional bupivacaine SA.

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