Etude comparée de la rachianesthésie conventionnelle et de l'anesthésie rachidienne et péridurale conjointe dans la chirurgie gynécologique

Abstract

A prospective study was carried out to compare the qualities of spinal block with those of combined spinal-epidural anaesthesia (CSEA). It included 63 patients, ranked ASA 1 or 2, aged between 35 and 75 years, scheduled for gynaecological surgery due to last more than 2 hours, and randomly allocated to two groups. In the first group (n = 34), spinal anaesthesia was carried out with the patients sitting, in the L 3–4 interspace, using 15 mg of hyperbaric bupivacaine with 0.4 mg of adrenaline. In the second group (n = 29), a catheter was inserted in the epidural space through the L 2–3 interspace, and spinal anaesthesia carried out as in the first group, using bupivacaine without adrenaline. Once the highest level of analgesia had been reached, aliquots of 0.5 % plain bupivacaine were injected through the epidural catheter, until anaesthesia of T 5 was obtained. In the spinal group, general anaesthesia was required in 3 cases, as anaesthesia only reached the T 12 level in 2 cases, and as surgery lasted longer than the spinal in the third one. In the CSEA group, excellent analgesia was obtained in all patients. Sensory blockade lasted 308 ± 48 min at the T 12 level, versus 162 ± 51 min in the spinal group (p < 0.025), and 361 ± 51 min at the L 2 level, versus 210 < 44 min in the other group (p < 0.025). « Topping upwas possible with the epidural catheter only, thus raising the level of sensory blockade, making it deeper, and increasing its duration. It avoids the use of general anaesthesia in case of failed spinal blockade. Pain relief may also be provided by this route. CSEA, a new approach to regional anaesthesia, combines the reliability of spinal blockade and the flexibility of epidural blockade.