Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study

Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of parturients. The aim of this study is to examine perioperative adverse events and hemodynamic stability among COVID-19 positive parturients undergoing spinal anesthesia. This prospective observational investigation was conducted at a tertiary teaching hospital in Jordan between January and June 2021, during which 31 COVID-19 positive parturients were identified. Each COVID-19 positive parturient was matched with a COVID-19 negative parturient who received anesthesia under similar operating conditions as a control group. Of the 31 COVID-19 patients, 22 (71%) were otherwise medically free, 8 (25.8%) were emergency cesarean sections. The sensory level of spinal block after 10 min was T8 (T6–T10) among COVID-19 positive group, compared to T4 (T4–T6) among control group (p = 0.001). There were no significant differences in heart rate, SBP, DBP, and MAP intraoperatively (p > 0.05). Twelve (36.4%) neonates born to COVID-19 positive patients were admitted to NICU, compared to four (11.8%) among control group (p = 0.018). There was no statistically significant difference in postoperative complications. In conclusion, spinal anesthesia is considered a safe anesthetic technique in COVID-19 parturients, and therefore it is the anesthetic method of choice for cesarean deliveries among COVID-19 patients.

Anesthesia for cesarean in pregnant with uncorrected failot tetralogy

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Hemodynamic changes can cause serious and fatal multi-organ complications, the choice of anesthesia is very difficult.Combined spinal epidural techniques have become an alternative to traditional neuraxial interventions; the advantages of spinal or subarachnoid block are fused with the flexibility of the epidural technique; they offer a fast, effective and minimally toxic spinal block, improve inadequate block, and prolong the duration of anesthesia with epidural supplements.The purpose of this article is to report the case of a pregnant woman with a diagnosis of uncorrected Tetralogy of Fallot and the anesthetic technique of effective establishment without producing harmful hemodynamic changes for the mother-child binomial.

Comparison Between Erector Spinae Plane Block and Spinal Block as Regional Anesthesia for Percutaneous Nephrolithotomy: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Erector spinae plane block (ESP) block is a novel interfacial block with a high margin of safety and highly effective for providing postoperative analgesia in Percutaneous Nephrolithotomy (PCNL). Combined with sedation, it may provide adequate surgical anesthesia with various advantages for PCNL procedure. OBJECTIVE The aim is to compare the effectiveness of ESP and subarachnoid block based on its conversion to a general anesthesia, interleukin-6 levels, postoperative pain, and opioid consumption in patients undergoing PCNL surgery. METHODS This is a randomized controlled trial on patients undergoing elective PCNL. All informed consent were obtained prior to the procedure. Patients were categorized into either ESP group or spinal group (1:1 ratio) with minimum sample size of 26 subjects in each arm using random allocation sampling. All patients were sedated using TCI propofol prior to receiving ultrasound-guided ESP block or spinal block. Sedation was maintained throughout the procedure. Sensory loss was evaluated by performing skin clamping at level of the incision before the surgery. RESULTS A total of 19 patients have been included in the study (7 ESP and 12 spinal subjects). A pilot study regarding its feasibility has been going as per February 2021. Primary results based on the pilot study are expected to be available by the early of 2022. CONCLUSIONS The randomized controlled trial is designed to provide high-quality evidence on comparison of effectiveness between erector spinae plane (ESP) block and spinal block as regional anaesthesia for percutaneous nephrolithotomy. CLINICALTRIAL ClinicalTrials.gov ID: NCT04947072

Comparative study of midline versus paramedian approach of spinal block in elderly.

Objective: To compare the efficacy of paramedian and midline approach for spinal block in elderly, in terms of success rate and number of attempts required by either approach. Study Design: Randomized Controlled Trial. Setting: Department of Anaesthesia, Madina Teaching Hospital Faisalabad. Period: January 2018 to December 2019. Material & Method: 120 elderly ASA I-III patients scheduled to undergo lower abdominal or limbs; general or orthopaedic surgery were randomly divided into two equal groups A and B of sixty patients. Patients were assigned into groups by lottery method. Group A patients were supposed to receive spinal block by midline approach while group B patients were planned to receive spinal block by paramedian approach. Results: It was observed that success rate was significantly high in group B, 98.3% as compared to group A, 80%, (p value 0.001). The number of attempts were significantly less in group B in comparison to group A (p-value 0.0001). Conclusion: The paramedian approach for spinal block in elderly patient’s offers ease of administration and a higher success rate as compared to midline approach.

Spinal Anesthesia Versus Popliteal and Adductor Canal Blocks for Ambulation After Pott's Fracture Surgery

Background Poorly controlled acute pain after surgery is associated with a variety of unwanted postoperative consequences, including patient suffering, distress, myocardial ischemia, prolonged hospital stay and increase of chronic pain. Neuroaxial block is used for postoperative pain management and decrease analgesic use. Objective To compare the effect of spinal anesthesia versus popliteal and adductor canal blocks for ambulation after pott's fracture surgery. Patients and Methods Type of Study: Randomized Clinical Trial. Study Setting: Ain Shams university hospitals. Study Period: 3 months from March to May 2019. Results On the other hand, the side effects of peripheral nerve block surgery limit the usefulness of the procedure. The common side effects are: incomplete block, direct nerve damage, localized hematoma and consequent ischemic damage, infection, and the risk of intravenous administration of local anesthetic. In our study we compared spinal anaesthia with nerve blocks for pott’s fracture and found that the time to perform spinal block was shorter than that needed to perform nerve blocks. Conclusion The adductor-popliteal canal provides longer duration of analgesic, better intraoperative hemodynamics, and decreased need for postoperative rescue analgesia in comparison with spinal anaesethia in patients with pot’s fracture ankle surgery.

Comparison of hemodynamic effect between the spinal anesthesia and saddle block during transurethral resection of the prostate

Background: The best technique for transurethral resection of prostate (TURP) is regional anesthesia. The hypotension is the major complication following spinal anesthesia. The hemodynamic changes is less with saddle block than spinal block. Aim and Objective: To compare hemodynamic effect between the spinal block and saddle block in TURP. Patients and methods: 50 patients between 50-70 years old ASA I – II prepared for TURP, divided randomly in two groups 25 pt. in each group. Group A received spinal 10 mg of hyperbaric bupivacaine (2 ml of 0.5%), were group B received saddle block 10 mg of hyperbaric bupivacaine (2 ml of 0.5%). The blood pressure, oxygen saturation, heart rate measured and recorded subsequently. The hypotension treated by 100 mcg bolus of phenylephrine. Results: In our study there was statically significant difference (p < 0.05) between group A which received spinal anesthesia and group B which received saddle block in hemodynamic effect. In which the incidence of hypotension and vasopressor requirement more in group A. Conclusion: Under saddle block the TURP can safely performed with low risk of hypotension and less requirement of vasopressor.

A Comparative Study of Intrathecal Bupivacaine with Fentanyl versus Plain Bupivacaine in Elective Lower Segment Caesarean Section

Pregancy is a very stressful condition for every women. Most of them live in a fear of complications and the safety of the unborn baby. Many have lots of questions and confusions when it comes to surgery. Regional anaesthesia is the best choice for a elective lower segment caesarean section. Making sure that the pregnant women co-operates to perform a lumbar puncture to deliever the drugs is at most important to have a succesful spinal block. It is also very important to choose drugs which last for longer time and provide analgesia even after the surgery. The practice of adding additives to local anaesthetic agents is very come from decades. The best and the safest additive with very low complication is the one which doesn’t affect the degree of anaesthetic block and has very safe haemodynamic response. Fentanyl is a time tested drug and it is very safe as per the available litracure and can be safely given in pregnancy. In this comparative study we are going to compare the potentail of fentanyl and bupivacaine with bupivacaine alone when given intrathecally

Difficult subarachnoid anaesthesia Prediction and Performance

Spinal anaesthesia (SA) has enjoyed a long history of success, celebrating soon its 125th anniversary. Puncturing the dura mater is considered a simple procedure, followed by a subarachnoid injection of a local anaesthetic (LA) agent into the cerebrospinal fluid (CSF). Even when the technique is performed perfectly, there is no guarantee that the block sits perfectly. Failure is not uncommon and encompasses a range from total absence of any neuraxial blockade, a partial block (insufficient height, quality or duration) or a patchy block. Table 1 lists a large number of potential causative factors that may result in a failed spinal anaesthetic, providing suggestions of solutions. Analysing each distinct phase of the procedure, i.e., spinal puncture, injection of local anaesthetic solution, spread of the local anaesthetic solution through the cerebrospinal fluid, action of the drug on subarachnoid neural tissue and patient management, are the keys to success at each stage. Mechanisms of failure of spinal anaesthesia include insufficient preparation and check of equipment and drugs, suboptimal positioning of the patient, unsuccessful puncture due to inadequate training or experience and inadequate use of needles and local anaesthetic solution.1-5 Besides operator, preparation, technique-dependent and patient-related factors (anatomical variations), there are also organisational factors (lack of block room, lack of adequate monitoring and trained personnel, insufficient time between block and onset of surgery, subsequent management following block). The use of the correct local anaesthetic (dose, volume, concentration) injected at the correct lumbar interspace is of paramount importance to produce an adequate spinal block for the right surgical intervention. Nevertheless, failures may still occur. Therefore, the anaesthetist should always have a contingency plan for a failed spinal block. Indeed, patients expect reliable surgical anaesthesia when undergoing an operation