English

Abstract

BACKGROUND: Since its introduction to clinical use in 1899 by August Bier, spinal anaesthesia has stood the test of time. In the last five decades it has gained in popularity. Apart from avoiding the complications of general anaesthesia, it is a simple, reliable and a cheap procedure and is relatively easy to master. But sometimes we come across partial or complete failure of spinal anaesthesia. In our rural setup to cut the cost of anaesthesia we give second spinal anaesthesia, immediately. METHODS: This prospective study was undertaken in our institution for three years, from March 2010 to April 2013 to 1) determine the incidence of failed spinal anaesthesia, 2) manage such cases by giving a second spinal immediately, if surgery has not started 3) find out the intraoperative, postoperative and late complications of the second spinal, if any. All patients undergoing lower abdominal, perineal and lower limb surgeries were included. After ten minutes of giving the spinal anaesthesia with bupivacaine, if no effect was seen as determined by sensory level and motor blockade, a second spinal was given preferably at a higher level. Demographic, anaesthetic and surgical data were collected and analysed. Patients were followed up in the postoperative room and in the ward till their discharge, for any possible complications. Patients were asked to report to the hospital if they developed any problems after discharge. RESULTS: 140 patients out of a total number of 2450 developed partial or complete failure. 62 complained of pain after surgery had started. Of these 62, 15 were managed by giving intravenous analgesia, seven by N2O/O2 50:50 inhalation, and thirteen by manipulating the table. 27 were converted to general anaesthesia. Out of 140 patients, 78 /2450(3.18%) were given a second spinal. In all these patients, the second injection acted well giving good muscle relaxation and adequate sensory block. One patient developed high spinal soon after the second injection. Another patient developed severe bradycardia and hypotension during the surgery. There were no complications in the postoperative period. None of the patients who have come for follow up; have reported any problems related to the second spinal anaesthetic to date. CONCLUSION: Repeating a spinal anaesthesia after a failed one is a good method of management, if conditions permit and proper care is taken. By this all the indications for giving spinal anaesthesia in the first instance is well maintained.