Combined Spinal Epidural Anaesthesia versus Spinal Anaesthesia with Clonidine for Hip Surgeries: A Randomized Comparative Study

2017 ◽  
Vol 4 (4 (Part-2)) ◽  
pp. 1208-1214
Author(s):  
Pushpa Agrawal ◽  
◽  
Surekha Shinde ◽  
Rohit Jakhalekar ◽  
Pravin Jadhav ◽  
...  
Keyword(s):  
Comparative Study ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Combined Spinal Epidural ◽  
Spinal Epidural

COMPARATIVE STUDY OF SEQUENTIAL COMBINED SPINAL EPIDURAL ANAESTHESIA VERSUS SPINAL ANAESTHESIA IN HIGH RISK GERIATRIC PATIENTS FOR MAJOR ORTHOPAEDIC SURGERY

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Sheetal .
Keyword(s):  
High Risk ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Geriatric Patients ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group A ◽  
Major Orthopaedic Surgery ◽  
Group B ◽  
Spinal Epidural

Sequential combined spinal epidural anaesthesia (Sequential CSEA) is probably the greatest advance in central neuraxial block in this decade for high risk geriatric patients because here the advantages of both spinal and epidural anaesthesia are summated avoiding the side effects. This study is designed to compare the clinical effects of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients undergoing major orthopaedic procedure. Sixty patients aged 65 to 80 years, ASA III were randomly allocated into two equal groups. Group A (n=30)  received sequential combined spinal epidural anaesthesia with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 20  mg  fentanyl  through  spinal  route, and the expected incompleteness of spinal block was managed with small incremental dose  of  0.5%  isobaric bupivacaine  through epidural catheter, 1.5 to 2 ml for every unblocked segment to achieve T10 sensory level. Group B (n=30) received spinal anaesthesia with 2 ml (10 mg) of 0.5% hyperbaric bupivacaine and 20 mg of fentanyl. Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (p< 0.01) along with the provision of prolonging analgesia as compared to group B. So sequential combined spinal epidural anaesthesia is a safe, effective, reliable technique with stable haemodynamic along with provision of prolonging analgesia compared to spinal anaesthesia for high risk geriatric patients undergoing major orthopaedic surgery. Keywords: Sequential combined spinal epidural anaesthesia, Spinal anaesthesia, Fentanyl, Geriatric

scholarly journals Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

2020 ◽  
Vol 08 (10) ◽  
pp. 132-147
Author(s):  
Sharmin Ara Begum ◽  
A. K. M. Akhtaruzzaman ◽  
Dilip Kumar Bhowmick ◽  
Debabrata Banik ◽  
Md. Afzalur Rahman ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Geriatric Patients ◽  
Combined Spinal Epidural ◽  
Spinal Epidural ◽  
Pulmonary Status

scholarly journals Comparison of levobupivacaine vs bupivacaine in thoracic spinal anaesthesia for laparoscopic cholecystectomies

2019 ◽  
Vol 7 (12) ◽  
pp. 4568
Author(s):  
Loveleen Kour ◽  
Madan Lal Katoch
Keyword(s):  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Neurological Complications ◽  
Combined Spinal Epidural ◽  
Thoracic Spinal ◽  
Long Acting ◽  
Group B ◽  
Spinal Epidural

Background: Levobupivacaine is the pure S enantiomer of racemic bupivacaine. It is a long acting variant that is less toxic to the heart and central nervous system. It has gained relevance and popularity in the modern anaesthetic practice. Thoracic spinal anaesthesia has been shown to an effective   and safe anaesthetic approach for a varied spectrum of surgeries including laparoscopic cholecystectomies.  Incorporation   of epidural catheter adds flexibility and the provision of postoperative analgesia. To adopt thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies was chosen in the study. This study aimed at comparing the efficacy of levobupivacaine and bupivacaine in thoracic combined spinal epidural anaesthesia for laparoscopic cholecystectomies.Methods: Total 60 ASA 1 and 2 patients scheduled for laparoscopic cholecystectomies were chosen for the purpose of this study extending from January 2019 to May 2019.  They were randomly divided into two groups - group L and group B. Both the groups received thoracic combined spinal anaesthesia using 2ml of 0.5% isobaric levobupivacaine and 25 µg (0.5ml) fentanyl in group L and 2ml of 0.5% isobaric bupivacaine and 25 µg (0.5ml) fentanyl in group B.  The duration of sensory and motor block, peak block height, maximum motor block achieved, haemodynamic variables and any postoperative neurological complications were evaluated.Results: Both the groups showed similar onset of sensory and motor block. The duration of motor block was similar in both the drug groups; however, levobupivacaine showed a significantly loner duration of sensory block.  There were no significant haemodynamic differences between the two groups and no postoperative neurological complications were seen in any patient.Conclusions: Levobupivacaine was found to be slightly better than bupivacaine in thoracic combined spinal epidural anaesthesia.

scholarly journals Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

2018 ◽  
Vol 6 (10) ◽  
pp. 3413
Author(s):  
Loveleen Kour ◽  
Kuldip C. Gupta
Keyword(s):  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Epidural Anaesthesia ◽  
Regional Anaesthesia ◽  
Hyperbaric Bupivacaine ◽  
Combined Spinal Epidural ◽  
Group I ◽  
Operative Complications ◽  
Lumbar Spinal ◽  
Spinal Epidural

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used.

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