scholarly journals A COMPARITIVE EVALUATION BETWEEN COMBINED SPINAL EPIDURAL BLOCK AND EPIDURAL BLOCK FOR LOWER ABDOMINAL SURGERIES

2021 ◽  
pp. 1-3
Author(s):  
Chandeshwar Choudhary ◽  
Praveen Kumar Singh ◽  
Debarshi Jana
Keyword(s):  
Epidural Anesthesia ◽  
Epidural Anaesthesia ◽  
Muscle Relaxation ◽  
Sensory Block ◽  
Epidural Block ◽  
Maximum Height ◽  
Randomised Study ◽  
Combined Spinal Epidural ◽  
Group B ◽  
Spinal Epidural

Introduction: Most of the lower abdominal surgeries are conducted under spinal or epidural anaesthesia. The purpose of this study is to evaluate combined spinal epidural anesthesia and epidural block in terms of efficacy, surgical analgesia and muscle relaxation in patients undergoing lower abdominal surgeries. Material and methods: This prospective randomised study was conducted at SKMCH, Muzaffarpur, Bihar where 60 patients of ASA I and II, aged 20-60 years of both sexes scheduled for elective lower abdominal surgeries were randomized into two groups. Group A – receiving epidural anaesthesia. 20ml of 0.5% plain bupivacaine was injected epidurally.1.5-2ml of 0.5% Bupivacaine was injected epidurally for every unblocked segment after the maximum height of block is reached so as to get the required T6 level. Group B – receiving combined spinal epidural anaesthesia. (2.5 ml) of 0.5% Bupivacaine (heavy) was deposited in the subarachnoid space.1.5-2ml of 0.5% bupivacaine was injected epidurally for every unblocked segment after 10 minutes to get required T6 height of block. Results: The changes in hemodynamic parameters observed between the two groups are statistically not significant. The time to achieve T6 sensory block was significantly shorter in CSE group when compared to epidural group. CSEA provided more degree of motor blockade and significantly good quality of analgesia compared to epidural anesthesia alone. The amount of bupivacaine required to produce the desired level of T6 blockade is 2.5 times less in CSEA compared to epidural anesthesia. Conclusion: Combined spinal epidural technique is effective, safe, with stable hemodynamics and superior to epidural anaesthesia in patients undergoing lower abdominal surgeries.

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 Combined spinal epidural anaesthesia versus epidural anaesthesia: a comparative study

2020 ◽  
Vol 10 (2) ◽  
pp. 36-39
Author(s):  
Pramesh Sunder Shrestha ◽  
Ninadini Shrestha ◽  
Anil Shrestha ◽  
Roshana Amatya ◽  
Bigen Man Shakya ◽  
...  
Keyword(s):  
Comparative Study ◽  
Epidural Anaesthesia ◽  
Epidural Block ◽  
Spinal Block ◽  
Epidural Group ◽  
Hyperbaric Bupivacaine ◽  
Chi Square ◽  
Cross Sectional ◽  
Group B ◽  
Spinal Epidural

Background: Regional anaesthesia are widely utilized in surgical gynaecology practice. The Com­bined Spinal Epidural Anaesthesia (CSEA) technique and Continuous epidural anaesthesia both have been extensively used in elective gynaecological surgeries. This prospective cross-sectional comparative study was designed to compare the quality of anaesthesia between CSEA and Epi­dural anaesthesia. Methods: Sixty-four patients between age group 15- 65 years of ASA grade I, II were randomly di­vided into 2 groups. Group A patients received CSEA using “double needle double interspace tech­nique” and were given 2.5 ml of 0.5% hyperbaric bupivacaine for spinal block. Group B patients received epidural block with catheter using 10 ml of 0.5% plain bupivacaine. In all patients, subse­quent dosage of 2 ml per unblocked segment 0.5% plain bupivacaine was administered through the epidural catheter to achieve a block up to T4-5. Mean was calculated using t-test, median with Mann Whitney U test and Chi-square test where appropriate and the Statistical Analysis was done using SPSS program, version 11.0. Results: The surgical anaesthesia and motor blockade occurred significantly early in CSEA group. Duration of analgesia was significantly shorter in CSEA (84.1±40.6 min) as compared to epidural group (138.6±32.9 min). The total amount of bupivacaine required to attain the same target level was two times in epidural group (p<0.05). Haemodynamic changes were comparable in both the groups. No neurological side effects were observed. Conclusions: Sequential CSEA is superior alternative to epidural block, which combines the advan­tages of spinal and epidural while minimizing their drawbacks in elective gynaecological surgeries.

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 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.

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