Abstract
Background: Aim of this prospective study was to evaluate the sensory block quality and hemodynamic effects in patients undergoing urologic surgery under Combined Sequential Spinal Epidural Anesthesia (CSSE). Methods: Fifty patients were included in the study. Inclusion criteria were age ≥ 18 years and surgery scheduled to last ≤ 2 hours. Patients with a history of hypertension, congestive heart failure, any active medication for cardiovascular disease or any other absolute or relative contraindication to spinal anesthesia were excluded from the study. Patients undergoing urologic procedures received CSSE with 4 ml of Levobupivacaine 0.075% intratecally, followed by 10 ml of Levobupivacaine 1.5% epidurally. Sensory block spread was assessed by a pin prick test. Cardiac index (CI), blood pressure (BP), heart rate (HR) and arterial saturation of O2 (SpO2) were continuously monitored and recorded. Before discharge, patient’s functional status was assessed by the Aldrete Score.
Highlights
Major surgery below the umbilical level requires excellent surgical conditions and prolonged and effective postoperative analgesia
combined spinal epidural anesthesia (CSE) technique provides better surgical conditions than with epidural block alone, since the spinal component allows a rapid onset of anesthesia, while the administration of local anesthetics into the epidural space via catheter allows to titrate the spread of block and to supplement anesthesia if insufficient [2]
The characteristics of neural block are reported in Table 2: on H10min of sensory block showed a significant difference in sensory block was reached at dermatomes T7 and T10 when compared with baseline
Summary
Major surgery below the umbilical level requires excellent surgical conditions and prolonged and effective postoperative analgesia In such conditions, combined spinal epidural anesthesia (CSE) has been proposed as an alternative technique to standard spinal anesthesia (SA) [1]. The combined sequential spinal epidural (CSSE) technique has been studied mostly for cesarean section, and it may be advantageous as well in other high-risk patients such as very old urologic patients, by increasing the safety of the central regional block [1,4,5,6,7]. Aim of this prospective study was to evaluate the sensory block quality and hemodynamic effects in patients undergoing urologic surgery under Combined Sequential Spinal Epidural Anesthesia (CSSE)
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