Comparison of block characteristics in continuous spinal anesthesia and continuous epidural anesthesia for lower limb orthopedic surgeries: An interventional study

Abstract

Background: Continuous epidural anesthesia (CEA) is commonly used in routine practice even though it needs a higher dose of local anesthetics (LA) and is sometimes associated with a patchy or unilateral block. Despite advantages, continuous spinal anesthesia (CSA) is underutilized because of concern related to infection and postdural puncture headache. Our aim was to compare the block characteristics and hemodynamic changes following CSA and CEA in lower limb orthopedic surgeries. Materials and Methods: After approval from the Institutional Scientific and Ethics Committee and Registration with (Clinical Trials Registry of India/2021/02/031575), a prospective, double-blind, randomized study was conducted in 144 patients, American Society of Anesthesiologists I-II, aged 18–65 years, scheduled for lower limb orthopedic surgeries. Patients were randomly divided into two groups according to anesthesia technique used (n = 72), i.e., Group CSA and Group CEA. Block characteristics, hemodynamic variables, intraoperative LA requirement, and complications were recorded. Results: Demographic and surgical data, grade of sensory and motor blockade, and incidence of complications were comparable in both the groups. Induction time was significantly shorter in CSA (8.14 ± 0.88 min vs. 15.75 ± 3.29 min, P < 0.0001). Performance time (5.31 ± 0.92 min vs. 4.92 ± 1 min; P = 0.008), duration of blockade (68.3 ± 4.23 min vs. 65.54 ± 4 min; P < 0.0001), and analgesia (230.48 ± 40.76 min vs. 222.86 ± 39.79 min; P = 0.024) were significantly longer in CSA. A significant fall in diastolic blood pressure and mean arterial pressure occurred in CEA. LA requirement was significantly lower in CSA (11.62 ± 2.5 mg vs. 65.35 ± 7.71 mg; P < 0.00001). Conclusions: Considering shorter induction time, prolonged sensory blockade, and analgesia with greater hemodynamic stability, CSA could be preferred over CEA for lower limb orthopedic surgeries.