Abstract
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
Highlights
Spinal anaesthesia is widely Practice in orthopaedic surgery
Group A (n=30) received sequential combined spinal epidural anaesthesia with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine and 20 mg fentanyl through 26G Whitacre spinal needle which was introduced through a 16G Tuohy needle in the epidural space
Both the groups were comparable according to age, sex, body weight, height, type of surgery, duration of surgery and type of patients according to American Society of Anaesthesiologist (ASA) status
Summary
Spinal anaesthesia is widely Practice in orthopaedic surgery. Combined spinal epidural, single segment, needle though needle technique is gaining popularity in modern anaesthesia practice. 1,2 It offers rapid onset, efficacy and safety with minimal chances of toxic effects combined with potential for improving an inadequate block and prolonging duration of analgesia Intraoperatively and post operatively.[3]. Single segment, needle though needle technique is gaining popularity in modern anaesthesia practice. 1,2 It offers rapid onset, efficacy and safety with minimal chances of toxic effects combined with potential for improving an inadequate block and prolonging duration of analgesia Intraoperatively and post operatively.[3] This technique reduces or eliminates some of the disadvantages of spinal anaesthesia while preserving their advantages.[3] Geriatric patients undergoing major surgery have a significantly higher incidence of morbidity and morality compared with younger age group because of their reduced cardio respiratory reserve and concomitant diseases.[4] An association can be made between American Society of Anaesthesiologist (ASA) classification and morbidity.[5] White et al noted that patients with hip fractures and ASA I and II were no more risk for mortality than age and sex adjusted controls (8% death per year).[6] those of ASA III status had mortality rates of 49% or 6.3 times that of their controls.[6]
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