Continuous Spinal Anesthesia Research Articles

Novel Use of the PECS II Block in Major Vascular Surgery: A Case Report

Patients presenting for major vascular surgery are often elderly, medically complex, and at increased risk for general anesthesia-related complications. A search of the published literature produced no citation regarding PECS II block in the setting of extra-anatomic bypass procedures. We present a case report describing the use of the deep injection of the PECS II block in this context. Although further investigation is needed to determine the role of truncal blocks in major vascular surgery, our case illustrates that peripheral nerve blocks, combined with continuous spinal anesthesia, may be used as an alternative to general anesthesia for axillofemoral-femoral bypass.

Effect of Continuous Spinal Anesthesia and Single Shot Spinal Anesthesia on Hemodynamics for Lower Abdominal and Hip Surgeries in Adults: An Observational Study

Effect of Continuous Spinal Anesthesia and Single Shot Spinal Anesthesia on Hemodynamics for Lower Abdominal and Hip Surgeries in Adults: An Observational Study

Continuous Epidural Versus Continuous Spinal Anesthesia for Elderly Patients Undergoing Radical Cystectomy: A Comparative Study

Continuous Epidural Versus Continuous Spinal Anesthesia for Elderly Patients Undergoing Radical Cystectomy: A Comparative Study

Continuous Spinal Anesthetic in a Patient with Severe Aortic Stenosis for Total Knee Arthroplasty

Patients with severe aortic stenosis represent a serious perioperative challenge for anesthesiologists when presenting for orthopedic surgery. Avoiding general anesthesia can be beneficial by averting the dramatic hemodynamic changes that can occur at induction and emergence. However, regional anesthesia can similarly produce significant alterations in sympathetic tone in blocked regions. We discuss the successful use of a continuous spinal anesthetic in a patient with severe aortic stenosis undergoing elective total knee arthroplasty.

Continuous spinal versus continuous thoracic epidural anesthesia for major abdominal surgery in patients with chronic obstructive pulmonary disease

Background Most anesthetists preferred general anesthesia for major abdominal surgery which was not devoid of complications in cases with chronic obstructive pulmonary disease (COPD). Recently, the use of neuraxial anesthesia is supported to avoid or decrease these complications. This study aimed at the description, evaluation, and comparison between the use of continuous spinal anesthesia (CSA) and continuous thoracic epidural anesthesia (CTEA) as a sole anesthesia for major abdominal surgeries in cases with COPD. Patients and methods Sixty patients of both sexes aged 40–75 years with American Society of Anesthesiologists physical status classes II and III complaining of COPD scheduled for various elective major abdominal operations were included. According to the neuraxial block type, the patients were randomly assigned into two equal groups with 30 patients in each. The first group (CSA group) received continuous lumbar spinal anesthesia and the second group (CTEA group) received continuous thoracic epidural anesthesia. The data recorded included patients’ demographic data, characteristics of the used neuraxial blockade, hemodynamic changes, changes in pulmonary functions, incidence of the various side effects, and postoperative pain severity. Results The final statistical analysis included 55 patients where five patients were excluded from the study. Although there were no statistically significant differences between both groups regarding demographics, hemodynamics, changes in pulmonary functions, side effects, surgeon, and patients’ satisfactions, and postoperative visual analog scale. The CSA group has faster block onset with less local anesthetic dose compared with the CTEA group (P<0.001). Also, there were statistically significant decrease in peak expiratory flow rate, forced expiratory volume in 1 s, and forced expiratory volume in 1 s/forced vital capacity at 1, 2, and 6 h postoperatively compared with the preoperative baseline values in both groups (P<0.05). Hypotension was significantly more frequent in the CTEA group than in the CSA group (P=0.047). Conclusion Although both CSA and CTEA can be used for anesthesia and for postoperative analgesia in major abdominal surgery in COPD patients, the CSA was easier, safer, had faster onset, gave more predictable block, with less hemodynamic instability, and less technical failure compared with CTEA. The preoperative optimization of the lung functions, intraoperative close observation, and postoperative neuraxial analgesia with chest physiotherapy improved the outcome.

Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy.

Continuous spinal anaesthesia for caesarean section in a patient with peripartum cardiomyopathy.

Randomized comparison of continuous spinal anesthesia versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries

Background Continuous spinal anesthesia (CSA) is a reliable method for providing effective anesthesia and offers considerable advantages over ‘single-shot’ spinal or epidural anesthesia, as it provides the performance of well-controlled anesthesia using small doses of local anesthetics and a definite end point with less failure rate. Materials and methods A total of 100 patients of American Society of Anesthesiology grades III–IV were scheduled for elective major orthopedic lower limb surgeries. They were divided into two groups: one received CSA using spinocath set, and the other group received continuous epidural anesthesia (CEA). The doses of local anesthetic used, hemodynamic variables, a degree of technical difficulties, and the incidence of complications were recorded. Results The performance time was significantly shorter in the CEA group. The total dose of bupivacaine and number of top-up doses were significantly smaller in the CSA group than in the CEA group. The onset of sensory blockade level and motor blockade was significantly longer with CEA. Regarding the mean arterial pressure, there was a statistically significant difference between the two groups. The number of patients treated for hypotension and total dose of ephedrine was more in CEA group, but there was no statistical difference between the two groups. No major complications were observed in any patient in both groups. Conclusion We conclude that CSA is an effective and safe choice with hemodynamic stability and negligible failure rate, for prolonged procedures in elderly high-risk patients and in those with possible difficulties in administration of general anesthesia.

Is regional anesthesia a safe technique for patients with severe ankylosing spondylitis undergoing total hip replacement surgery?

Background: Authors report two cases of regional anesthesia management whom were scheduled for total hip replacement surgery due to ankylosing spondylitis.Methods: Mouth opening, and cervical spine movements were limited. Cervical ostheophytes have been recognized to cause distortion of the airway and can lead to unexpected difficulties during intubation.Results: In present first case report we described continuous spinal anesthesia for a patient with severe ankylosing spondylitis. We achieved successful anesthesia using epidural catheter by insertion of spinal area. Awake epidural anesthesia management was described in second case of the study.Conclusions: Authors suggest that regional anesthesia can be safely and effectively used as an alternative to general anesthesia in patients with ankylosing spondylitis.

Continuous spinal anesthesia for 1 cases of cesarean section after cerebral vascular malformation

Maintaining hemodynamic stability is the most important to the parturient woman who undergoing cesarean section after cerebral vascular malformation. Avoiding high blood pressure caused by intracranial deformity and vascular rupture again after healing, avoid low blood pressure leading to maternal cerebral blood flow insufficiency and fetal distress caused by decreased placental blood flow. Continuous spinal anesthesia(CSA) by microcatheter injection of drugs into the subarachnoid space, and can provide more stable hemodynamic status with rapid onset and perfect anesthetic effect in obstetric patients. Through this case, the particularity of caesarean section management and the advantages of CSA in patients with cerebral vascular malformation were introduced in this paper. Key words: Intracranial vascular malformation; Cesarean section; Continuous subarachnoid anesthesia; Hemodynamics

Continuous spinal anaesthesia: A retrospective analysis of 318 cases.

Background and Aims:Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety.Methods:This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications. Statistical analysis was done using Chi-square test.Results:Three hundred and eighteen patients (94%) successfully underwent surgery using CSA. Twenty cases (6%) had failed CSA, of which five of them had CSA insertion failure, while the rest failed to complete the operation under CSA, thus requiring conversion to general anaesthesia. Patients who have had an initial intrathecal local anaesthetic (LA) volume ≥1.5 ml had higher odds (odds ratio (OR) 2.78; 95% confidence interval [CI], 1.70–4.57) of developing hypotension compared to those who had <1.5 ml (P < 0.001). There were no reported post-dural puncture headache, neurological sequelae or infection.Conclusion:CSA is a useful anaesthetic technique with low failure rate. The key to achieving haemodynamic stability is by giving a small initial bolus, then titrating the block up to required height using aliquots of 0.5 ml of intrathecal LA through the catheter.

Postdural puncture headache and maternal hemodynamics after single-shot and continuous spinal anesthesia using epidural kit for cesarean section

Background The aim of this study was to compare the incidence of postdural puncture headache and maternal hemodynamics after single-dose spinal anesthesia and continuous spinal anesthesia using epidural kit with prophylactic intrathecal saline injection for a cesarean section. Patients and methods Ninety patients scheduled for elective cesarean section were randomly allocated to one of the three groups. Group A (30 patients) received single-dose spinal anesthesia using a 25-G Quincke type point spinal needle. Groups B and C (30 patients each) received continuous spinal anesthesia using 18-G epidural needles and intrathecal 20-G epidural catheters. In group C, the patients received 5 ml normal saline intrathecally before local anesthetic injection and 10 ml just before catheter removal 24 h after insertion. Incidence and severity of postdural puncture headache, block characteristics, patient satisfaction, hemodynamic parameters, and incidence of complications were recorded. Results Significantly longer sensory and motor regression times with higher total bupivacaine dose in group A compared with groups B and C. The hypotension and ephedrine dose needed were significantly more in group A compared with the other two groups. Nausea and vomiting were significantly more in group A compared with the other two groups. Incidence of postdural puncture headache was 16.7% in group B and 10% in both groups A and C. Patient satisfaction was significantly more in group C compared with the other two groups. Mean arterial pressure and heart rate were significantly lower in group A compared with the other two groups at 10, 15, 20, and 25 min Conclusion Incidence of postdural puncture headache with continuous spinal anesthesia with keeping of the intrathecal catheter for 24 h and prophylactic intrathecal saline is comparable to single-dose spinal anesthesia for a cesarean section. It allows using lower doses of local anesthetic with better hemodynamic stability, fewer complications, and better patient satisfaction.

Single-shot spinal anesthesia with heavy bupivacaine in two regimens versus continuous spinal anesthesia in elderly patients undergoing hip surgery: a prospective randomized controlled study

Background Elderly patients with hip fracture are a medical challenge. Spinal anesthesia (SA) is effective, rapid, has minimal effect on mental status, reduces blood loss, and thromboembolic complications. The continuous spinal anesthesia (CSA) produces more sensory–motor blockade with fewer hemodynamic effects. Intrathecal opioids can achieve successful SA using decreased doses of local anesthetics. Aim The aim of this study is to compare the safety and the efficacy of single-shot SA with heavy bupivacaine in two regimens versus continuous SA in elderly patients undergoing hip surgery. Patients and methods This study was carried out on 60 patients aged 65 years or older patents scheduled for hip surgery. Patients were randomized into three groups (n=20): group A SA with hyperbaric bupivacaine 7.5 mg, group B spinal fentanyl anesthesia (SFA) SA with hyperbaric bupivacaine 5 mg+25 μg fentanyl, and group C (CSA) with continuous SA. Heart rate (HR), mean arterial pressure (MAP), onset, duration, and the level of sensory block and onset, duration and score of motor block were recorded. Complications, amounts of fluids, and/or blood products and the use of vasopressors, total doses of bupivacaine, need for sedation, supplementation, and anesthetic failure were recorded. Assessment of pain was done using by visual analog score for 6 h postoperatively. Results MAP showed significant decrease in group A. The onset of sensory block and time to reach T10 showed significant increase in group C. Time of regression of sensory block T12 showed significant decrease in group C. The onset of motor block showed significant increase in group C. The duration of the motor block showed significant decrease in group C. Scores of motor block in the three groups show insignificant difference. Conclusion CSA had the advantage of being significantly hemodynamically stable and lower dose of local anesthetics and ephedrine than SA. Besides, intrathecal opioids improve the quality of spinal block.

Assessment of cases of continuous spinal anaesthesia: A clinical study

Background: Continuous spinal anaesthesia (CSA) is an under‑utilized anaesthetic technique suitable for surgeries of the lower extremity, perineum and lower abdomen. The present study was conducted to determine the use of continuous spinal anaesthesia in patients. Materials & Methods: The present study was conducted on 126 patients with American Society of Anaesthesiologists (ASA) physical status grade I or II who underwent any surgery. Their demographic profiles, type and duration of surgery were analyzed. The success of CSA, technical evaluation and complications were assessed. Results: Out of 126 patients, males were 62 and females were 64. Comorbidities were hypertension seen in 45, diabetes mellitus in 40, IHD in 20 and CVA in 15. The difference was significant (P

Continuous Spinal Anaesthesia (CSA) for Emergency Laparotomy in High-Risk Elderly patients: Technique and Outcomes of a Prospective Service Evaluation

Continuous Spinal Anaesthesia is a recognized technique for providing anaesthesia for various surgical procedures. It may be an alternative to general anaesthesia in high-risk elderly patients requiring emergency laparotomy. The objective was to evaluate the benefits of continuous spinal anaesthesia in providing effective anaesthesia for emergency laparotomy, in enhancing recovery after major abdominal surgery and in reducing length of stay in the intensive care unit in high-risk elderly patients. Prospective service evaluation was performed at a tertiary care university hospital. High-risk elderly patients were offered both general anaesthesia and continuous spinal anaesthesia. An 18-gauge macro catheter was inserted into the intrathecal space through a 16-gauge Tuohy needle. Sedation was maintained with remifentanil. Prophylactic anti-emetics were administered. Blood pressure was maintained with an infusion of metaraminol. Over a 27-month period, 25 high risk elderly patients were offered continuous spinal anaesthesia and general anaesthesia for emergency laparotomy. Twenty-one patients opted for continuous spinal anaesthesia. Three patients required conversion to general anaesthesia. In the remaining 18 patients, continuous spinal anaesthesia provided adequate anaesthesia for major bowel surgery. Mean length of stay in level 2 care was 1.6 days. 30-day mortality was 14%. None of the patients reported post dural puncture headache. There were no neurological complications. Emergency laparotomy carries well-recognised intra and postoperative risks and in the elderly cohort, these risks are significant and probably life threatening. Continuous spinal anaesthesia is a well-established technique that may offer some reduction of both intra and postoperative risks with an improved immediate recovery from major emergency surgery.

Delayed Neuraxial Hematoma in Parturient With Fontan Circulation Following Neuraxial Anesthesia for Cesarean Section

(Reg Anesth Pain Med. 2016;41(6):773–775) This case report described the challenges posed by parturients with Fontan circulation, including the treatment for congenital heart disease and anticoagulation management during cesarean delivery performed under neuraxial anesthesia. Pregnancy, in general, increases the risk of venous thromboembolism and this is a common complication in patients with Fontan circulation. In this case, the 30-year-old parturient with Fontan circulation developed a neuraxial hematoma four days after her cesarean delivery performed with continuous spinal anesthesia. Morbid obesity and superficial phlebitis added to the complications in this case.

Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia.

The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.

The Wiley Spinal Catheter-Over-Needle System for Continuous Spinal Anesthesia: A Case Series of 5 Cesarean Deliveries Complicated by Paresthesias and Headaches

(Reg Anesth Pain. Med 2016;41:405) Two of the most effective methods used for providing intrapartum pain relief are epidural analgesia and combined spinal-epidural analgesia. Some of the advantages that spinal analgesia has over epidural analgesia include more rapid onset, a definitive endpoint for placement, usage of lower doses of local anesthetic/opioid, and superior sacral coverage. A continuous spinal analgesia technique offers the advantages of being able to prolong the duration of intrathecal analgesia, titrate the dose to effect, and rapidly convert a labor analgesic to a surgical anesthetic in case of a cesarean delivery.

Comparative Study between Continuous Thoracic Epidural vs. Thoracic Spinal Anaesthesia in Breast Surgery

Objective: The aim of this work is to compare between thoracic epidural anesthesia (TEA) and segmental thoracic spinal anesthesia (TSA) conducted for breast surgeries as regard to hemodynamic changes (blood pressure, heart rate, oxygen saturation, ETCO2), postoperative pain control, postoperative analgesic requirements, surgeon satisfaction, postoperative ambulation time and perioperative complication. Setting: Al-Hussein and Sayed Galal hospitals. Patients and Methods: This work was done upon 40 female patient undergoing breast surgeries. Patients were divided randomly into 2 equal groups according to the type of anesthetic technique had been chosen. Group I were anaesthetized by thoracic epidural anesthesia and group II by segmental thoracic spinal anesthesia. Results: Recovery and ambulation time was more or less equal in the both groups. This is important since the patient can readily return to her family and social environment and can decrease the cost of the procedure, although this was not specifically assessed in this study. Post-operative pain was compared at the time 0, 1, 2, 4 and 8 hour by using VAS. Conclusion: We found that epidural blockade a preferred choice of anesthetic management for breast surgery.

Complications of 761 Short-term Intrathecal Macrocatheters in Obstetric Patients: A Retrospective Review of Cases Over a 12-Year Period

(Int J Obstet Anesth. 2016;25:30–36) Continuous spinal anesthesia may have some advantages over epidural catheter and single-shot spinal techniques in obstetrics, particularly in certain groups of high-risk parturients. However, use of intrathecal catheters (ITCs) seems underutilized on many obstetric units, with anesthesiologists citing the fear of infection, nerve damage or postdural puncture headache (PDPH). At the authors’ institution, which is a tertiary care hospital, ITCs are placed intentionally in specific high-risk obstetric patients, including those with morbid obesity, severe cardiopulmonary disease or spinal abnormalities. They also used ITCs following accidental dural puncture (ADP) with a 17-G epidural needle. This study reviewed retrospectively the complications experienced by 761 parturients who received an ITC for labor analgesia and/or anesthesia for cesarean delivery (CD) during the time period of 2001 to 2012 period.

Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

BackgroundAnesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Continuous epidural anesthesia (CEA) is generally accepted as the routine method of regional anesthesia for vascular surgery of the lower limb.Continuous spinal anesthesia (CSA) has been reported to be more rapid in action, with good sensory and motor block, fewer hemodynamic disturbance and side effects when compared to continuous epidural anesthesia (CEA), and single dose spinal anesthesia (SDSA).Patients and methodsForty adult patients with depressed systolic function (EF 45% or less) scheduled for lower abdominal surgeries were subjected to our study. Under full aseptic precautions subarachnoid space was accessed in the setting position by an epidural needle at L3–4 and 2 ml of hyperbaric bupivacaine (10 mg) was injected into subarachnoid space, then an epidural catheter was inserted in the subarachnoid space for 3 cm. Anesthesia was maintained by Top up doses of plain bupivacaine 0.5% 1.2 ml.ResultThere were no differences in demographic characteristics of patients, procedure’s duration, and ASA physical status classification. There were no significant changes in hemodynamics throughout the procedure. Hypotension occurred in 5% of patients, bradycardia occurred in 10% of patients and arrhythmia occurred in 2.5% of patients. There were no postoperative ECG changes and postoperative Troponin was negative. There was no postoperative Neurological deficit or Post dural puncture headache.ConclusionWe can conclude that, CSA was effective and safe technique for patients with cardiomyopathy undergoing lower abdominal surgeries.