Abstract
Objective:To evaluate the evolution pattern of epidural block after rotating the needle tip 45° to the operative side and evaluate its effects on patients’ hemodynamics and recovery profile in those undergoing arthroscopic knee surgery.Methods:Forty participants were randomly subdivided into control and rotation group (n=20). An 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L4-5 and pushed forward into the epidural space through parasagittal approach, in control group, the needle was pushed forward to the epidural space in cephaldad 90 degrees. For the rotation group, the needle was pushed forward to the epidural space and the tip was rotated 45 degrees to the surgical side.15 mL of bupivacaine 0.5% was injected and evolution of sensory and motor blocks until 2-segment regression of the sensory level below to T10 as well as total duration of motor block and surgery were recorded. Hemodynamic parameters (HR, MAP, and SPO2), hypotension, fluid intake, vasopressors, first ambulation and spontaneous urination were recorded. Statistical analysis was performed using SPSS and P≤0.5 considered significant.Results: Sensory block up to T10 level, Complete motor block and time for 2-segment regression of sensory level were earlier in the 45°-rotation than in the control group (p<0.001). Total duration of motor block in control group was lower than rotation group (p<0.001).Hypotension, N&V, vasopressors and fluid intake showed no statistically difference between the two groups (p=0.219). First spontaneous urination and ambulation were significantly lower in rotation group (p<0.001).Conclusion:45 degrees’ needle rotation to the surgical side provides a faster block evolution and hastened recovery profile with no significant difference in hemodynamic fluctuations.Clinical trial registry: IRCT20130518013364N7
Highlights
Due to increasing age of patients undergoing surgery and higher co-morbidity, there has been an upsurge of interest in choice of a safe and effective technique for an efficient perioperative anesthesia and for effective postoperative analgesia [1, 2]
The study was registered in Iranian Registry of Clinical Trials (IRCT20130518013364N7) and written informed consent was obtained from all the participants prior the study
Unilateral epidural block may occur after the placement of an epidural catheter [18]
Summary
Due to increasing age of patients undergoing surgery and higher co-morbidity, there has been an upsurge of interest in choice of a safe and effective technique for an efficient perioperative anesthesia and for effective postoperative analgesia [1, 2]. Neuraxial blockade has a wide range of clinical applications for surgery, acute postoperative pain management, and chronic pain relief [7, 8]. Epidural, and caudal neuraxial blocks result in one or a combination of sympathetic, sensory or motor blockade depending on the dose, concentration, or volume of local anesthetic administered. Despite these similarities, there are significant technical, physiologic, and pharmacologic differences [9]. Spinal anesthesia requires a small volume of drug that is almost devoid of systemic pharmacologic effects to produce rapid (
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