Continuous Spinal Anesthesia Research Articles

A Comparison of Intrathecal Analgesia with Fentanyl or Sufentanil After Total Hip Replacement

We designed this study to compare the postoperative analgesic effects of intrathecal fentanyl and sufentanil, the end points being onset, quality, and duration of action. A total of 42 geriatric patients, scheduled for elective total hip replacement under continuous spinal anesthesia, were randomized in two double-blinded groups as soon as they experienced a pain score higher than 3 of 10 on the visual analog scale in the recovery room. Either 7.5 μg sufentanil or 40 μg fentanyl in 2 mL normal saline were intrathecally administered. Pain scores, rescue analgesia (ketorolac and morphine), and adverse effects (respiratory depression, postoperative nausea and vomiting, and itching) were recorded for 24 h after surgery. In both groups, comparing sufentanil to fentanyl, the time to a pain score <3 (9 ± 9 vs 11 ± 8 min), the time to the lowest pain score (18 ± 6 vs 20 ± 15 min), and the time to the first systemic analgesic intervention for a pain score >3 (241 ± 102 vs 214 ± 120 min) were comparable as were the analgesic requirements during the first 24 h. We conclude that, after total hip replacement, both lipid soluble opioids produce excellent analgesia with comparable onset, duration of action, and low incidence of minor adverse effects. Implications: We compared the postoperative analgesic properties of 40 μg intrathecal fentanyl and 7.5 μg sufentanil after total hip replacement. Both opioids provided satisfactory analgesia, with comparable onset (11 ± 8 vs 9 ± 9 min) and duration of action (214 ± 120 vs 241 ± 102 min), as well as low incidence of minor side effects.

Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients

The intraoperative effects of continuous spinal anaesthesia, and the efficacy of postoperative continuous spinal analgesia in 48 elderly high risk patients undergoing major abdominal, vascular or orthopaedic surgery is reported. Intraoperative anaesthetic technique proved to be safe and provided satisfactory results in the immediate postoperative period. Furthermore, the postoperative analgesic regimen which involved intrathecal fentanyl and bupivacaine, and intravenous tenoxicam, provided effective analgesia for all patients. The intrathecal analgesic regimen was administered continuously through a PCA pump which had the facility to provide bolus doses when requested in predetermined lockout intervals. The mean doses of fentanyl and bupivacaine infused intrathecally for the first 24 h postoperatively were 14.5 +/- 1.5 microg h(-1) (mean +/- SD) and 0.72 +/- 0.08 mg h(-1) (mean +/- SD), respectively, while the requirements for analgesia decreased progressively overtime but lasted for 118 h. The technique provided effective analgesia with low pain scores that was reflected by the ease in performing physical exercises and the pleasant co-operation with the physiotherapist. Only minor complications related to anaesthesia/analgesia were encountered.

Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients

The intraoperative effects of continuous spinal anaesthesia, and the efficacy of postoperative continuous spinal analgesia in 48 elderly high risk patients under-going major abdominal, vascular or orthopaedic surgery is reported. Intraoperative anaesthetic technique proved to be safe and provided satisfactory results in the immediate postoperative period. Furthermore, the postoperative analgesic regimen which involved intrathecal fentanyl and bupivacaine, and intravenous tenoxicam, provided effective analgesia for all patients. The intrathecal analgesic regimen was administered continuously through a PCA pump which had the facility to provide bolus doses when requested in predetermined lockout intervals. The mean doses of fentanyl and bupivacaine infused intrathecally for the first 24 h postoperatively were 14.5 ± 1.5 μg h−1 (mean ± SD) and 0.72 ± 0.08 mg h−1 (mean ± SD), respectively, while the requirements for analgesia decreased progressively over time but lasted for 118 h. The technique provided effective analgesia with low pain scores that was reflected by the ease in performing physical exercises and the pleasant co-operation with the physiotherapist. Only minor complications related to anaesthesia/analgesia were encountered.

Transient Neurologic Symptoms After Epidural Analgesia

Transient Neurologic Symptoms After Epidural Analgesia

Comparison of three catheter sets for continuous spinal anaesthesia

Comparison of three catheter sets for continuous spinal anaesthesia

Continuous spinal anaesthesia and analgesia — worth another try!

Continuous spinal anaesthesia and analgesia — worth another try!

Continuous spinal anaesthesia/analgesia for abdominal aortic aneurysm repair and post-operative pain management

The intra-operative management of two patients with chronic obstructive pulmonary disease and cardiovascular pathology, who underwent peripheral reconstructive vascular surgery under continuous spinal anaesthesia, is described. Furthermore, continuous intrathecal analgesia was also continued in the post-operative period and provided effective pain relief that was reflected by the favourable surgical outcome.

Scanning Electron Microscopy Study on Spinal Microcatheters

Scanning Electron Microscopy Study on Spinal Microcatheters

Continuous spinal anesthesia: A continuous history?

Continuous spinal anesthesia: A continuous history?

Continuous Spinal Anesthesia

Continuous Spinal Anesthesia

Over-the-needle versus microcatheter-through-needle technique for continuous spinal anesthesia: A preliminary study

Background and Objectives. A new catheter-over-needle design (Spinocath, B. Braun) has been developed to minimize problems and complications of continuous spinal anesthesia with microcatheters, which include difficult catheter insertion, failure of insertion, breakage, inadequate anesthesia, postdural puncture headache, and, rarely, development of cauda equina syndrome. Methods. A comparative evaluation of this new catheter (22-gauge Spinocath) to the microcatheter (28-gauge Portex) was performed to study the problems of insertion, complications, quality of anesthesia, and postoperative analgesia in a prospective, randomized manner. Patients were allocated to two groups of 10 each: catheter-over-the-needle group (group I) and microcatheter-through-the needle (group II). Postoperative protocol consisted of an infusion of 0.125% isobaric bupivacaine delivered with a syringe infusion pump for 24 hours. Results. The two groups were comparable in relation to age, sex, type of surgery, median height of the block, and the time taken for catheter insertion and surgery. Spontaneous backflow of cerebrospinal fluid (CSF) through the catheter with the needle in position was possible only in the spinocath group ( 8 10 cases). Initial introduction of the catheter into the subarachnoid space (8 vs 3: chi-square = 5.05; P = .03) and threading of the catheter were easier (8 vs 3 cases: chi-square = 5.05; P = .03) in group I. Aspiration of CSF was easy in group I in all (10 vs 2: chi-square = 13.33; P = .004). Complications such as resistance to drug injection, kinking ( P < .05), inadequate anesthesia, and supplementation with general anesthesia were seen only in group II. Postoperative pain relief was comparable in both groups ( P > .05). Both groups were comparable hemodynamically in the intra- and postoperative periods. Conclusions. Insertion, maintenance, and clinical effects were better achieved with the catheter-over-the needle design compared to the microcatheter. These preliminary findings need to be confirmed by a larger study.

Over-the-Needle Versus Microcatheter-Through-Needle Technique for Continuous Spinal Anesthesia

Over-the-Needle Versus Microcatheter-Through-Needle Technique for Continuous Spinal Anesthesia

Continuous Spinal Anaesthesia

Continuous Spinal Anaesthesia

Continuous spinal anaesthesia or continuous epidural anaesthesia for post-operative pain control after hip replacement?

Both continuous spinal anaesthesia and continuous epidural anaesthesia are supposed to provide adequate post-operative pain relief. The purpose of this randomized, prospective study was to compare the quality of analgesia, occurrence of side effects and patient satisfaction between spinal and epidural administration of bupivacaine during the first post-operative 72 h. One hundred and two patients scheduled for hip arthroplasty were randomly assigned to one of two groups: Group 1 received continuous spinal anaesthesia for intra-operative and post-operative management, Group 2 received continuous epidural anaesthesia. Immediately after surgery, the continuous spinal anaesthesia-group received a 1-mL bolus (bupivacaine 0.25%), followed by a continuous infusion of 10 mL over 24 h. The continuous epidural anaesthesia-group received a 10-mL bolus (bupivacaine 0.25%), followed by 2 mL h-1. The level of pain was gauged from a verbal rating score and from a visual analogue scale; the degree of motor blockade was recorded using the Bromage score. In the continuous spinal anaesthesia-group 90.2% reported complete analgesia on the verbal rating scale, but only 21.6% of the continuous epidural anaesthesia-group did. The visual analogue scale scores given by the continuous spinal anaesthesia-group were significantly lower than those of the continuous epidural anaesthesia-group. The percentage of patients with a motor block was significantly higher in the continuous spinal anaesthesia-group on the day of surgery and at the first post-operative day. During the first 24 h, nausea and vomiting occurred more often in the continuous epidural anaesthesia-group. The satisfaction was considered excellent in 92.2% of the continuous spinal anaesthesia-group and in 70.6% of the continuous epidural anaesthesia-group. It is concluded that continuous spinal anaesthesia and continuous epidural anaesthesia are effective and safe for post-operative pain relief after hip replacement. Compared with continuous epidural anaesthesia, continuous spinal anaesthesia provides faster onset of pain relief, ensures better analgesia and results in more satisfied patients.

Continuous spinal anaesthesia or continuous epidural anaesthesia for post-operative pain control after hip replacement?

Both continuous spinal anaesthesia and continuous epidural anaesthesia are supposed to provide adequate post-operative pain relief. The purpose of this randomized, prospective study was to compare the quality of analgesia, occurence of side effects and patient satisfaction between spinal and epidural administration of bupivacaine during the first post-operative 72 h. One hundred and two patients scheduled for hip arthroplasty were randomly assigned to one of two groups: Group 1 received continuous spinal anaesthesia for intra-operative and post-operative management, Group 2 received continuous epidural anaesthesia. Immediately after surgery, the continuous spinal anaesthesia-group received a 1-mL bolus (bupivacaine 0.25%), followed by a continuous infusion of 10 mL over 24 h. The continuous epidural anaesthesia-group received a 10-mL bolus (bupivacaine 0.25%), followed by 2 mL h−1. The level of pain was gauged from a verbal rating score and from a visual analogue scale; the degree of motor blockade was recorded using the Bromage score. In the continuous spinal anaesthesia-group 90.2% reported complete analgesia on the verbal rating scale, but only 21.6% of the continous epidural anaesthesia-group did. The visual analogue scale scores given by the continuous spinal anaesthesia-group were significantly lower than those of the continuous epidural anaesthesia-group. The percentage of patients with a motor block was significantly higher in the continuous spinal anaesthesia-group on the day of surgery and at the first post-operative day. During the first 24 h, nausea and vomiting occured more often in the continuous epidural anaesthesia-group. The satisfaction was considered excellent in 92.2% of the continuous spinal anaesthesia-group and in 70.6% of the continuous epidural anaesthesia-group. It is concluded that continuous spinal anaesthesia and continuous epidural anaesthesia are effective and safe for post-operative pain relief after hip replacement. Compared with continuous epidural anaesthesia, continuous spinal anaesthesia provides faster onset of pain relief, ensures better analgesia and results in more satisfied patients.

In vivo diffusion-weighted magnetic resonance microscopy of rat spinal cord: Effect of ischemia and intrathecal hyperbaric 5% lidocaine

Background and Objectives. Pathophysiologic mechanisms underlying persistent neurologic deficits after continuous spinal anesthesia using hyperbaric 5% lidocaine are still not well understood. It has been suggested that high-dose intrathecal lidocaine induces irreversible conduction block and even ischemia in white matter tracts by breakdown of the blood-nerve barrier. In this study, we use diffusion-weighted magnetic resonance microscopy to characterize the effect of intrathecal hyperbaric 5% lidocaine in rat spinal cord. The parameter measured with DWM, is an “apparent diffusion coefficient,” (ADC), which can be used to exclude the presence of ischemia. Methods. Female Fischer CDF rats were used. Group 1 (n = 5) was exposed to ischemia, group 2 (n = 7) was exposed to intrathecal 5% hyperbaric lidocaine, and group 3 (n = 5) was exposed to intrathecal 7.5% glucose. Diffusion-weighted MR images in group 1 were acquired before and after ischemia induced by cardiac arrest and in groups 2 and 3 rats prior to and during perfusion of the spinal catheter with either 5% hyperbaric lidocaine or 7.5% glucose. Results. Ischemia decreased the ADC by 40% in gray matter and by 30% in white matter of spinal cord. Continuous intrathecal anesthesia with hyperbaric 5% lidocaine did not affect the spinal cord ADC. Further, 7.5% intrathecal glucose had no effect on ADCs in gray or white matter of spinal cord. Conclusion. Ischemia reduced the ADC in both spinal cord white and gray matter. Hyperbaric 5% lidocaine did not affect the spinal cord ADC during the first 1.5 hours. We suggest that 5% hyperbaric lidocaine does not induce irreversible neurologic deficits by causing spinal cord ischemia.

Risk of permanent neurologic sequelae after continuous spinal anesthesia

Risk of permanent neurologic sequelae after continuous spinal anesthesia

Anesthetic care for the child with morquio syndrome: general versus regional anesthesia

Morquio syndrome is a subtype of the mucopolysaccharidoses (MPS IV) characterized by the intracellular accumulation of keratin sulfate. Anesthetic issues related to the primary disease process include infiltration of tissues with keratin sulfate leading to distortion of upper airway anatomy with difficult or impossible endotracheal intubation, infiltration of the cervical spine with odontoid hypoplasia placing these patients at risk for atlanto-axial subluxation and quadriparesis, as well as alterations in cardiorespiratory function. Two children with Morquio syndrome who required anesthetic care during lower extremity orthopedic procedures are presented. The anesthetic implications of Morquio syndrome are reviewed. General anesthesia was used in one case, whereas continuous spinal anesthesia, which was used in the second case, is reported for the first time in a child with mucopolysaccharidoses.

Risk of Permanent Neurologic Sequelae after Continuous Spinal Anesthesia

Risk of Permanent Neurologic Sequelae after Continuous Spinal Anesthesia

The Neurotoxicity of Drugs Given Intrathecally (Spinal)

The Neurotoxicity of Drugs Given Intrathecally (Spinal)