Single-dose Spinal Anesthesia Research Articles

Transüretral Cerrahi Vakalarinda, Sürekli Spinal ve Tek Doz Spinal Anestezi Tekniklerinin Hemodinami, Duyusal ve Motor Blok Seviyesi Üzerine Etkilerinin Karşilaştirilmasi

Aim: In this study, it was aimed to compare in patients undergoing transurethral resection surgery: 1- The effectiveness of single-dose and continuous spinal anesthesia techniques, 2- Hemodynamic changes, sensory-motor block levels and durations, anesthetic drug doses and side effects. Method: Forty American Society of Anesthesiology I–III patients in the age group of 40–75 years who were scheduled for transurethral surgery were randomly divided into two groups: single dose spinal anesthesia (Group 1) (n = 20) and continuous spinal anesthesia (Group 2) (n = 20). The patients' hemodynamic data, analgesia status and motor block levels were evaluated. Results: With regard to the hemodynamic parameters, the mean values of systolic–diastolic blood pressure and heart rate were found to be significantly lower in the single dose spinal anesthesia group (Group 1) than in the continuous spinal anesthesia group (p < 0.05). In terms of sensory and motor block levels, the maximum block level was T9 in the continuous spinal anesthesia group, while it was T8 in the single dose spinal anesthesia group (p < 0.05). Upon reaching T10, two-segment regression and sensory and motor block termination times were found to be significantly lower in the continuous spinal anesthesia group when compared to the single dose spinal anesthesia group (p < 0.05). There was no difference between the two groups in terms of Bromage score values (p > 0.05). In the continuous spinal anesthesia group, the mean dose and volume of the local anesthetic required to achieve analgesia in the T10 dermatome were found to be 7.12 ± 1.46 ml and 1.4 ± 0.29, respectively. Furthermore, the amount of fluid administered intraoperatively was found to be significantly lower in the continuous spinal anesthesia group than in the single dose group (p < 0.05). Conclusion: With the continuous spinal anesthesia method, it can be titrated and by using lower doses of local anesthetic, a level of sensory-motor blockade close to the single-dose spinal anesthesia method and a more stable hemodynamics can be achieved.

Continuous spinal anaesthesia

Continuous spinal anaesthesia (CSA) is an infrequently used anaesthetic technique, where an intrathecal catheter (ITC) allows titrated injection of local anaesthetic into the intrathecal space to produce a subarachnoid block. Unlike single dose spinal anaesthesia (SDSA) where a fixed larger dose can result in an unpredictable block height and haemodynamic instability, titratable CSA allows lower doses to be used and the ability to extend the duration of anaesthesia if required.

The use of intra-operative navigation during complex lumbar spine surgery under spinal anesthesia

BackgroundSpinal anesthesia is a safe and effective alternative to general anesthesia in both simple and complex lumbar surgery with numerous reported advantages leading to increased recent utilization. One potential barrier to the use of spinal anesthesia in lumbar surgery is the popularity of intraoperative computed tomography (CT) imaging. Intraoperative CT necessitates motionless patients and adds time to procedures, issues that may make surgeons hesitant to use concomitant spinal anesthesia. To date, the use of both techniques simultaneously has not been well described. ObjectiveWe propose that single-level lumbar fusions utilizing intraoperative CT scan acquisition and navigated instrumentation are feasible under single-dose spinal anesthesia without detrimental effect on image quality and navigation accuracy or need for spinal anesthetic re-dosing due to the additional time necessary. MethodsWe describe operative characteristics and intra-operative timing for our first five cases of transforaminal lumbar interbody fusion (TLIF) completed with intraoperative CT scan acquisition and navigated instrumentation performed under spinal anesthesia. ResultsThe five patients ranged in age from 59 to 79 years, with an average body mass index of 27.0 kg/m2. The average total operative time for each surgery 109.2 min, including approximately 6.3 min required for CT scan acquisition. There were no complications and post-operative imaging demonstrated no malpositioned pedicle screws. ConclusionSingle-level TLIF procedures utilizing intraoperative CT acquisition and navigated instrumentation can be feasibly completed under single-dose spinal anesthesia without need for intraoperative apneic periods and without deleterious effect on instrumentation accuracy.

A Comparative Study of Fractionated Versus Single Dose Injection for Spinal Anesthesia During Cesarean Section in Patients with Pregnancy-Induced Hypertension.

BackgroundLocal anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being.ObjectivesThis study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section.MethodsThis single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18 - 40 years, and BMI of 18.5 - 35 kg/m2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (MarcaineTM, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD).ResultsThere was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0 - 25) mg in the FD group vs. 15 (0 - 30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59).ConclusionsIn obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.

The Analgesic Efficacy of Transverse Abdominis Plane Block versus Epidural Block after Caesarean Delivery: Which One Is Effective? TAP Block? Epidural Block?

Introduction and Objective TAP block has gained popularity to provide postoperative analgesia after abdominal surgery but its advantage over epidural analgesia is disputed. For lower abdominal surgeries, epidural analgesia has been the gold standard and time-tested technique for providing postoperative analgesia, but contraindications for the same would warrant need for other equally good analgesic techniques. The objective of this study is to compare the analgesic efficacy of both the techniques. Materials and Methods Eighty patients in the ASA I-II risk group, undergone an elective C-section, were randomly assigned to the study. In the TAP group, before the C-section, a single-dose spinal anaesthesia was performed by administering 3 ml of 0.5% hyperbaric bupivacaine to the patients when they were in the sitting position. After the C-section, an ultrasound-guided bilateral TAP block was performed in these patients in the recovery room for postoperative analgesia. In the single-dose EPI group, the patients received 16 cc of isobaric bupivacaine, 3 mg of morphine, and 50 mcg of fentanyl, making a total volume of 20 cc and being administered to the epidural space. Results A higher level of patient satisfaction was observed in the EPI group (p=0.003). The amount (mg) of total analgesics received by the patients in the first 24 hours of the postoperative period was statistically significantly higher (p=0.021) in the TAP group compared to the EPI group. The visual analogue scale (VAS) scores of the EPI group were significantly lower compared to that of the TAP group (p < 0.001). Conclusion The epidural anaesthesia is still the golden standard to achieve a postcaesarean analgesia. Epidural anaesthesia is a considerably effective method in controlling the postoperative pain. We are of the opinion that epidural anaesthesia should be preferred in the first place to achieve a successful postcaesarean analgesia as it provides more effective pain control.

Comparing adductor canal block with local infiltration analgesia in total knee arthroplasty: A prospective, blinded and randomized clinical trial

Study objectiveTotal knee arthroplasty (TKA) is associated with significant pain post-operatively.Our hypothesis is that adductor canal block (ACB) would be superior to local infiltration analgesia (LIA) in terms of providing analgesia, while still preserving quadriceps strength and enabling early postoperative rehabilitation. DesignA prospective, blinded and randomized clinical trial between LIA and ACB was conducted. SettingTertiary care urban hospital. Patients40 patients (ASA I to III) undergoing primary TKA under single-dose spinal anesthesia were prospectively randomized from January 2014 to October 2015. InterventionsThe LIA group received local infiltration of Ropivacaine 150 mg, Ketorolac 30 mg, Morphine 10 mg, and Adrenaline 200 mcg in a total volume of 75 mls, administered intraoperatively by the surgeon.The ACB group was given an ACB postoperatively by one of the study investigators at the end of surgery with 30 mls of 0.5% Ropivacaine. MeasurementsThe primary outcome was total Morphine consumption in the first 24 h.Secondary outcomes included total Morphine consumption in the first 48 h, pain scores, quadriceps strength, the Timed Up and Go test (TUG), the 30 s Chair Stand Test (30s-CST) and length of hospital stay. Main resultsThe median (interquartile range) 24 h Morphine consumption was 6 mg (2.3–18.3) in the ACB group and 17.5 mg (12–24.3) in the LIA group, p = 0.004. The 48 h Morphine consumption was 14.5 mg (7.5–28.5) in the ACB group as compared to 24 mg (14–33.8) in the LIA group, p = 0.03. There were no statistically significant differences in the other secondary outcomes. ConclusionACB group had statistically significant reduced total Morphine consumption in the first 24 and 48 hours as compared to LIA group, with no statistically significant differences in functional outcomes of TKA patients.

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.

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.

The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery

BackgroundThe aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. MethodsSixty years or older, ASA I–II or III, 50 patients were included in the study. 12.5mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at T10 dermatome, additional 1mL of 0.25% levobupivacaine were administered through the catheter in every 10min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. ResultsCSA technique provided better hemodynamic stability compared to SDSA technique particularly 90min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. ConclusionCSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation.

Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study

The purpose of this study was to assess maternal satisfaction with single-dose spinal analgesia for the management of obstetric pain in Indonesian women. The investigation included 62 laboring women with single pregnancy at term, with 45 primigravidas and 17 multigravidas. The participants' ages ranged from 15 to 29 years. All participants were screened for physical health and were classified as healthy according to the American Society of Anesthesiologists classification system. All 62 parturients received single-dose spinal anesthesia with a 27-gauge pencil-point needle at either the L3-4 or L4-5 intervertebral interspace, with a combination of bupivacaine, 2.5 mg; morphine, 0.25 mg; and clonidine, 45 microg. Maternal satisfaction, duration of pain relief, and side effects were studied. The overall maternal satisfaction with the single-dose spinal technique for labor analgesia in our study group was high, with 50 patients (81%) being very satisfied, and 7 patients (11%) being satisfied with the quality of labor analgesia. Forty-nine patients (79%) stated that they would select single-dose spinal analgesia for pain control in labor in the future. Our study was the first one in Indonesia to assess maternal satisfaction with single-dose spinal analgesia for labor pain. We concluded that single-dose spinal analgesia with a combination of bupivacaine, morphine, and clonidine provided effective labor pain control for Indonesian women, and maternal satisfaction with this technique was very high. This technique is very cost-effective and should be recommended for routine obstetric pain control in Indonesia and other developing countries.

Single dose spinal anesthesia for the management of labor pain in the developing world: defining the benefits

Single dose spinal anesthesia for the management of labor pain in the developing world: defining the benefits

Controversies in the delivery suite: obstetrical anesthesia for the parturient with cavernous transformation of the portal vein

Cavernous transformation of the portal vein (CTPV) is a rare disorder resulting from extrahepatic portal vein thrombosis and development of collateral venous circulation. I herein present the first reported case of a pregnant patient with CTPV associated with persistent consumptive coagulopathy and chronic thrombocytopenia. Single-dose spinal anesthesia was safely conducted for an uneventful cesarean delivery.

Continuous spinal anaesthesia: what's new and what's not

Continuous spinal anaesthesia combines the advantages of single-dose spinal anaesthesia, rapid onset and a high degree of success, with those of a continuous technique. The introduction of micro-catheters invigorated interest in the technique and allowed its expansion to additional populations and surgical procedures. However, multiple cases of cauda equina syndrome associated with micro-catheters and (primarily) hyperbaric lidocaine solution led to withdrawal of micro-catheters from the US market, casting doubt over the safety of continuous spinal anaesthesia as a whole. A decade after these events it is possible to look back at the experience with continuous spinal anaesthesia for operative anaesthesia and postoperative analgesia and to compare it with the available alternatives. From this perspective, continuous spinal anaesthesia remains a useful and safe technique. Future research should focus on the comparison of continuous spinal anaesthesia with the combined spinal/epidural technique and the use of newer spinal agents.

Anesthetic management of a parturient with congenital cavernous transformation of the portal vein and chronic thrombocytopenia.

Cavernous transformation of the portal vein is a rare disorder resulting from extrahepatic portal vein thrombosis and development of collateral venous circulation. We report a case of a pregnant patient with congenital cavernous transformation of the portal vein associated with persistent consumptive coagulopathy and chronic thrombocytopenia. Single dose spinal anesthesia was safely conducted for an uneventful cesarean delivery.

Ten Milligrams Intrathecal Bupivacaine Is Too High for Spinal Anesthesia for Hip Surgery in the Geriatric Population

Allegheny General HospitalPittsburgh, Pennsylvania.bbendavid@mindspring.comIn Reply:—Our finding of a 90% incidence of hypotension after single-dose (“conventional”) spinal anesthesia in elderly patients is consistent with the high incidence of hypotension reported in the literature. 1Others have reported a 100% incidence of hypotension necessitating vasopressor treatment. 2Buggy et al. 3found a 75% incidence of systolic hypotension even with a volume loading of 500 ml hetastarch, 6%, plus 500 ml Hartmann’s solution. The strong association of spinal hypotension with ST depression in this patient population is cause for concern. 4Our choice of a 10-mg dose of spinal bupivacaine was intended to represent conventional practice and not necessarily the lowest dose of bupivacaine. This choice was arbitrary and, I suspect, underestimates the dosing used by many of our colleagues. The important point, however, is that, rather than treat hypotension, one can avoid it by using a low-dose local anesthetic plus an opiate spinal technique.It is true that this technique provides a “nociceptive block” and does not provide a profound motor block. Certainly, there are surgeries in which the need for an intense motor block would necessitate higher doses of local anesthetic if one is to use spinal anesthesia. Likewise, there are surgeries (e.g. , ambulatory) in which the absence of a profound motor block may be advantageous.Our article did not intend to suggest that there is no other way to reduce the hypotension of spinal anesthesia. Titrated dosing with continuous spinal anesthesia is fairly effective in this regard, 2but it is my impression that many practitioners prefer the speed and simplicity of a single-shot technique. Although unilateral spinal anesthesia might offer greater hemodynamic stability than bilateral blockade, at best it is impractical (time-consuming) when surgery is to be performed with the patient in the supine position.

A.245 Single-dose versus continuous spinal anaesthesia in the elderly

A.245 Single-dose versus continuous spinal anaesthesia in the elderly

Hemodynamic Effects of Spinal Anesthesia in the Elderly

Sixty elderly patients (> 70 yr old) undergoing surgery for hip fracture were prospectively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia (CSA) versus single-dose spinal anesthesia (SDSA). Patients were randomized into two groups (CSA group: n = 30; SDSA group: n = 30). The SDSA patients received 10-15 mg of 0.5% hyperbaric bupivacaine (based on age and height), and the CSA patients received a starting dose of 5 mg of 0.5% hyperbaric bupivacaine, followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached. Onset of anesthesia, noninvasive hemodynamic variables and the need for ephedrine were studied for 4 h after induction of anesthesia. Spinal anesthesia was successful in all patients. Decreases in mean arterial pressure were significantly less frequent and less pronounced in the CSA group (19.9% +/- 1.6% of the baseline value) than in the SDSA group (40.2% +/- 1.9%, P < 0.0001). The mean dose of ephedrine was significantly less in the CSA group (1.8 +/- 0.7 mg, administered to only 37% of patients) than in the SDSA group (19.4 +/- 3.3 mg administered to all patients, P < 0.0001). No late complications related to the spinal anesthesia technique were observed in either group. We concluded that CSA, using small titrated doses of 0.5% hyperbaric bupivacaine, is safe, efficient, and provides better hemodynamic stability than SDSA in elderly patients.

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

Continuous Spinal Anesthesia with Invasive Hemodynamic Monitoring for Surgical Repair of the Hip in Two Patients with Severe Aortic Stenosis

25%, severe global hypokinesis, and moderate mitral regurgitation. The patient also had a history of hypertension, atria1 fibrillation (AF), and noninsulin-dependent diabetes. His preoperative medications included digoxin, furosemide, enalapril, nitroglycerin patch, and glyburide. He had no known drug allergies. On physical examination, the patient was 180 cm in height and weighed 62 kg. Heart rate (HR) and blood pressure (BP) were 74 bpm and 120/70 mm Hg, respectively. Head and neck evaluation was significant for a Mallampati class II airway and decreased range of motion of the neck. The cardiac examination revealed an irregularly irregular heart beat with a grade 3/6 systolic murmur. The lungs were clear to auscultation. The electrocardiogram (ECG) revealed AF with a ventric

Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients

One hundred and twenty-eight ASA I-III patients less than 40 yr of age, undergoing orthopaedic or trauma lower limb surgery, were allocated randomly to receive either continuous spinal anaesthesia (CSA) using a 32-gauge polyimide microcatheter with a permanent stylet (Rusch/TFX Medical, Duluth, GA, USA) or single-dose spinal anaesthesia (SDSA) with a 24-gauge x 103-mm Sprotte spinal needle (Pajunk, Germany). Plain bupivacaine (0.5%) was used as the local anaesthetic. The initial doses were 1 ml (5 mg) of CSA and 3 ml (15 mg) of SDSA, while the re-injection doses were 1 ml (5 mg) in the CSA group. SDSA was quicker to perform: mean 4.4 (SD 1.6) min compared with 6.2 (2.6) min for CSA (P < 0.01). Times to onset and surgical anaesthesia were also significantly greater in the CSA group (P < 0.01). The quality of the block was better in the SDSA group (P < 0.05), but was associated with greater haemodynamic instability (P < 0.05). The segmental level of analgesia was significantly lower in the CSA group (median T10 (range T12-T8)) than in the SDSA group (T9 (T11-T5)) (P < 0.05). There were no significant differences in the incidence of postoperative complications, with two mild spinal headaches in both groups. We conclude that CSA using a microcatheter in young patients is difficult to perform and affords no advantages over SDSA with a small gauge atraumatic needle.