Spinal Anesthesia In Patients Research Articles

1069 Assessing the Safety and Efficacy of Spinal Anesthesia in Patients With Higher Risk Comorbidities

INTRODUCTION: Spinal anesthesia (SA) is a safe and effective alternative to general anesthesia (GA) for lumbar surgery. Widespread adoption of SA has not occurred presumably due to surgeons’ concerns for difficulties in management of patients with comorbidities. Obesity (BMI =30 kg/m2), anxiety, obstructive sleep apnea, re-operation at the same level, and multilevel operations have recently been identified as risk factors for perioperative complications. METHODS: A retrospective analysis of 422 patients who underwent thoracolumbar surgery under spinal anesthesia by a single surgeon at a single academic center (2017-2021) was carried out. Patient demographics, comorbidities, as well as intraoperative and postoperative complications were abstracted from the medical record. In the overlapping groups, 149 patients had a BMI =30, 95 had diagnosed anxiety, 79 underwent multilevel surgery, 98 had obstructive sleep apnea, and 65 had a prior operation at the same level. The control group included 132 patients without these risk factors. Differences in perioperative outcomes were assessed with the Kruskal-Wallis rank sum test, Pearson's Chi-squared test, or Fisher's exact test using R (The R Foundation, v 4.1.1, Vienna, Austria). RESULTS: Postoperative pneumonia was observed in two patients in the anxiety group and in one patient in the reoperative group (p-value < 0.05). There were no other statistically significant differences in intraoperative and postoperative complications within the entire cohort including when stratified by number of comorbidities. Rate of spinal fusion was comparable among groups, though mean length of stay and operative time were different (p-value < 0.001). CONCLUSIONS: Spinal anesthesia is a feasible and safe anesthetic modality for most patients, including those with significant comorbidities. An updated algorithm for SA candidate selection is thus recommended.

Risk Factors of Post Dural Puncture Headache in Cesarean Section Patients: A Multivariate Analysis Study

Background: The use of spinal anesthesia in patients undergoing cesarean section (CS) is at risk of experiencing post-dural puncture headache (PDPH). This is influenced by several factors.Objective: This study aimed to assess the effect of risk factors on the occurrence of PDPH in patients undergoing CS under spinal anesthesia.Methods: The study design is a nested case-control study with independent variables influencing the incidence of PDPH in CS with spinal anesthesia. Samples were taken from CS patients with spinal anesthesia at the Central Surgical Installation of Dr. Kariadi General Hospital, who met the inclusion and exclusion criteria.Result: A total of 74 patients were included in the multivariate analysis, which showed that neurological disorders with p-value = 0.069; OR= 9,306; 95% CI = 0.842-102.828 and the number of punctures with p = 0.060; OR= 4.798; 95% CI = 0.997-23.075 is the most significant risk factor for the incidence of PDPH in CS patients. There was an additive effect which indicated that mobilization of more than 6 hours mutually reinforces the occurrence of PDPH in CS patients.Conclusion: Preoperative risk factors such as a history of neurological disorders increase the incidence of PDPH in CS patients. Intraoperative risk factors in this study were total puncture and needle size, increasing the incidence of PDPH in CS patients. Post-operative risk factors, in this case, immobilization, increase the incidence of PDPH in CS patients. Preoperative, intraoperative, and post-operative risk factors, together or separately, increase the incidence of PDPH in patients undergoing CS.

Spinal versus general anesthesia for hip arthroscopy—a pandemic (COVID) and epidemic (opioid) driven study

ABSTRACT The purpose of this study is to compare general anesthesia (GA) to spinal anesthesia (SA) for hip arthroscopy, based on measurable perioperative parameters. The pandemic signaled a change from GA to SA, and thus a retrospective review was performed of the first 120 consecutive SA cases compared to the last 120 GA cases prior to the pandemic. Demographic data included age, sex, BMI, preop narcotic usage and procedure performed. The groups were compared for post-anesthesia care unit length of stay, entry and discharge visual analog scale (VAS) scores, morphine mg equivalent usage, need for regional blocks and untoward events. Additionally, the length of time from entry to the operating room until completion of induction anesthesia was compared. Demographically, the groups were virtually identical. SA used significantly less morphine mg equivalent (6.0 versus 8.1; P = 0.005), had more needing no narcotics (17 versus 7; P = 0.031), fewer requiring blocks (1 versus 14; P = 0.001) and lower entry VAS scores (5.2 versus 6.2; P = 0.003). Five early SA patients required catheterization for urinary retention, and this was avoided later in the study by having patient void on call to operating room and avoiding anticholinergic agents. Completion of induction anesthesia was 0.8 min longer for SA. Hip arthroscopy can be effectively performed with either GA or SA. SA results in statistically significant better post-anesthesia care unit pain control, reflected by lower entry VAS, less need for narcotics and fewer requiring regional blocks compared to GA. Urinary retention, a potential problem of SA, is minimized with routine precautions.

Spinal Anesthesia Reduces Perioperative Polypharmacy and Opioid Burden in Patients Over 65 Who Undergo Transforaminal Lumbar Interbody Fusion

Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce polypharmacy and opioid administration is warranted. We aim to compare the perioperative polypharmacy and dose of administered opioids in patients ≥65 years who undergo transforaminal lumbar interbody fusion (TLIF) under SA versus general anesthesia (GA). A retrospective analysis of 200 patients receiving a single-surgeon TLIF procedure at a single academic center (2014-2021) was performed. Patients underwent the procedure with SA (n=120) or GA (n= 80). Demographic, procedural, and medication data were extracted from the medical record. Opioid consumption was quantified as morphine milligram equivalents (MME). Statistical analyses included χ2 or Student's t-test. Patients receiving SA were administered 7.45 medications on average versus 12.7 for GA patients (P < 0.001). Average perioperative opioid consumption was 5.17 MME and 20.2 MME in SA and GA patients, respectively (P < 0.001). The number of patients receiving antiemetics and opioids remained comparable postoperatively, with a mean of 32.2 MME in the GA group versus 27.5 MME in the SA group (P= 0.14). Antiemetics were administered less often as a prophylactic in the SA group (32%) versus 86% in the GA group (P < 0.001). SA reduces perioperative polypharmacy in patients ≥65 years undergoing TLIF procedures. Further research is necessary to determine if this reduction correlates to a decrease the incidence of postoperative cognitive dysfunction and delirium.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.

Evaluation of the safety, efficacy and technical advantages of spinal anesthesia in patients undergoing single lower lumbar level minimally invasive transforaminal lumbar interbody fusion, as an alternative to general anesthesia: a prospective study

Background: In spinal anesthesia, patients experience shorter OT, quicker recovery and ambulation, better post-operative analgesia and fewer complications than general anesthesia. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) shows fewer complications and early ambulation than open TLIF. Our study aims to assess spinal anesthesia’s safety, efficacy and technical benefits in MIS-TLIF. Methods: Patients unresponsive to conservative treatment for 6-8 weeks underwent MIS TLIF for lower lumbar degenerative pathologies. The demographic data, OT entry to incision time, blood loss, bandaging to exit from OT time, post anesthesia care unit (PACU) time, post-op complications, requirement of analgesia, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, hospital stay, fusion rates and satisfaction scores were noted and assessed. Results: The study included a total of 200 patients undergoing MIS-TLIF with mean age being 54.32±10.36 years; mean surgery time being 165.23±21.41 minutes; and mean blood loss being 123.56±65.14 ml. The mean OT entry to incision time was 28.91±9.63 minutes, while the mean bandaging to exit time was 7.43±4.12 minutes. The mean PACU stay was 41.35±5.78 minutes. The mean hospital stay was 3.28±1.23 days, with 97% patients showing solid radiographic fusion while 92.5% patients were fully satisfied with the surgery. VAS and ODI scores were significantly improved as compared to the pre operative status. Conclusions: Spinal anesthesia for lower lumbar MIS-TLIF is cost effective and safe alternative to general anesthesia with lesser post operative pain and other side effects; taking into consideration proper patient selection for the same.

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial.

Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in 'opioid-free' and 'opioid-based' TCSA. After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into 'opioid-free' (bupivacaine alone) and 'opioid-based' (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02-0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2-0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher's exact tests. The 'opioid-based' group performed significantly better compared with the 'opioid-free' group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). The 'opioid-based' TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the 'opioid-free' group in patients undergoing major abdominal surgery.

A PROSPECTIVE OBSERVATIONAL STUDY OF INTRAVENOUS ONDANSETRON AND PALONOSETRON IN ATTENUATING HYPOTENSIVE RESPONSE FOLLOWING SPINAL ANESTHESIA IN PATIENTS UNDERGOING ELECTIVE CESAREAN SECTION

Objective: To compare the efficacy of prophylactic administration of intravenous ondansetron and palonosetron in attenuating hypotensive response following spinal anesthesia in patients undergoing elective cesarean section. Methods: This was a comparative study in which 84 patients aged 18–35 years of American Society of Anesthesiologists physical status II, scheduled for elective cesarean section under spinal anesthesia (SA) were included based on predefined inclusion and exclusion criteria. 84 patients undergoing elective cesarean sections were divided into two groups to receive either ondansetron or palonosetron before SA. Vital signs were monitored, with interventions for hypotension or bradycardia. Data on vital signs, vasopressor use, neonatal Apgar scores, and post-operative symptoms were collected and analyzed. For statistical purposes, a P value less than 0.05 was taken as statistically significant. Results: The mean ages and body mass indexes (BMIs) of the groups were similar, with no significant statistical difference (p=0.674 and p=0.3583, respectively). Heart rates, systolic and diastolic blood pressures showed minor differences, but only a few instances were statistically significant. Mean arterial pressures differed significantly at multiple intervals, but no clinical hypotension was observed. SPO2 levels remained stable and comparable in both groups. Average phenylephrine usage was also similar, with no significant difference. The incidence of hypotension, sedation scores, and incidence of bradycardia were comparable. Neonatal outcomes, measured by APGAR scores, showed no significant difference, indicating similar newborn health status in both groups. Conclusion: Prophylactic ondansetron, as well as palonosetron, were equally effective in reducing the incidence and severity of hypotension in healthy parturients following spinal anesthesia with hyperbaric bupivacaine for elective LSCS.

The Relationship Between Anxiety Levels and Pre-operative Sleep Quality Disorders for Spinal Anesthesia Patients

Background: According to data, the number of surgery patients has increased significantly over time. All hospitals worldwide recorded 140 million patients in 2017, 148 million in 2019, and 1.2 million in Indonesia. Surgery might threaten a person's body, integrity, or life and generate anxiety. Patients can be anxious before surgery under anaesthesia. Chronic anxiety can create stress and sleep difficulties. People with sleep issues are young adults. Sleep disorders are conditions that cause discomfort or interfere with a desirable lifestyle due to alterations in rest patterns. Purpose: Understanding how worry affects preoperative sleep quality in spinal anaesthesia patients at Hj. Anna Lasmanah Banjarnegara Hospital. Methods: This type of research is descriptive correlation using a cross sectional design by distributing questionnaires of anxiety level (APAIS) and sleep quality (AIS). Findings: the findings regarding the anxiety levels of the 65 participants indicated that among the total of 65 respondents, 23 individuals (or 35.4%) reported having moderate anxiety. Furthermore, in terms of sleep quality disorders, moderate insomnia was reported by most respondents, comprising 28 individuals (43.1%). The significance value of p = 0.000 (&lt;0.05) obtained from the Spearman's Rho correlation test indicates that anxiety levels and sleep quality disorders are significantly associated in preoperative spinal anaesthesia patients. Conclusion: There is a strong relationship between anxiety level and preoperative sleep quality disorders in spinal anesthesia patients.

Layered and Thoracic Segmental Spinal Anaesthesia in Patients with Kyphoscoliosis for Various Surgeries: A Case Series

Kyphoscoliosis involves exaggerated anterior and lateral curvatures of the spine, affecting the dorsolumbar spine. Associated multiple organ system dysfunctions cause difficulties with both general and regional anaesthetic techniques. Co-existing neuromuscular disorders, pulmonary infections, difficulties in securing the airway, postoperative pulmonary morbidities, and the need for mechanical ventilation associated with general anaesthesia make neuraxial anaesthesia the most widely used technique in these cases. Continuous neuraxial techniques in these patients offer advantages over single-shot spinal anaesthesia in achieving the desired level of anaesthesia, managing patchy blocks, extending the duration of anaesthesia, and providing postoperative analgesia, but they are technically more challenging. Single-shot spinal anaesthesia can be a simple, safer, and effective alternative for surgical procedures of shorter duration. Performing thoracic segmental spinal anaesthesia in these patients is very challenging due to the complete distortion of anatomy and possible obliteration of neuraxial spaces. Layered spinal anaesthesia involves combining multiple local anaesthetics with different baricities to produce a successful subarachnoid block. Present series is reported with successful and uneventful use of the layered and thoracic segmental spinal anaesthetic technique in patients with kyphoscoliosis for various surgeries, including laparoscopic procedures.

Effect of Prewarming on Skin Temperature Changes After Spinal Anesthesia in Transurethral Resection of the Bladder

PurposeMonitoring of peripheral skin temperature changes is an objective and rapid method to evaluate the success of neuraxial block after spinal anesthesia. The aim of this study is to investigate the effect of prewarming on peripheral temperature changes after the administration of spinal anesthesia. DesignRandomized, prospective, single-blind study. MethodsIn this study, patients scheduled for transurethral resection of the bladder surgery under spinal anesthesia were divided into two groups: those with active prewarming and those without active prewarming. The groups were compared in core and skin temperature changes after administration of spinal anesthesia, length of stay in the postanesthesia care unit, shivering score, and the thermal comfort scale. FindingsA statistically significant difference was found between the groups on time for a 1 °C increase in ankle and toe skin temperatures (P < .001). There was a statistically significant difference between the groups in core temperature measurements (P < .001). When thermal comfort was compared between the groups, a statistically significant difference was found (P < .001). Patients' shivering score (P = .704), and length of stay in the postanesthesia care unit (P = .059) between the groups were similar. ConclusionsSkin temperature changes in the prewarming group were lower, and this group had a lower rate of increase than the nonprewarming group. Therefore, skin temperature changes in the lower extremity can be used to determine the success of spinal anesthesia in patients who are prewarmed, with the awareness of these differences.

Intravenous Ondansetron Efficacy in Preventing Post Spinal Shivering during Lower Segment Caesarean Section

Objective: To determine IV Ondansetron efficacy in preventing post-spinal shivering during LSCS. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Mar 2019. Methodology: A total of 60 women undergoing LSCS under spinal anaesthesia were included. Group-A was given 8 mg/4 ml Ondansetron, while Group-B was given 4 ml Normal Saline 0.9% IV immediately before induction of spinal anaesthesia. Body temperature, level of sensory block, and shivering scores during the peri-operative period were recorded. After surgery, patients were shifted to Post Anaesthesia Care Unit (PACU). Shivering was graded using Crossley and Mahajan 5-item scale. Injection Tramadol 1mg/kg intravenously was used as a rescue anti-shivering drug. Results: The majority of the patients 33(55.0%) were between 18-25 years of age. Efficacy of Intravenous Ondansetron in preventing post-operative shivering during spinal anaesthesia in patients undergoing caesarean section was seen in 26 86(67%) patients (Group-A) as compared to 17(56.67%) patients in the Control Group (Group-B) (p-value=0.010). Conclusion: The study concluded that there was less post-operative shivering with intravenous Ondansetron during spinal anaesthesia in patients undergoing caesarean section as compared to the Control Group.

Ultrasound-Guided Preoperative Fascia Iliaca Compartment Block for Pain Relief During Positioning for Spinal Anesthesia in Patients With Hip Fracture.

Background Fractures around the hip are common in the elderly. For surgical management, the subarachnoid block is the preferred anesthesia technique. Positioning these patients for anesthesia is challenging because of pain. Analgesia in the form of preoperative perineural anesthesia is gaining popularity. We observed the analgesic efficacy of preoperative ultrasound-guided fascia iliaca block, its efficacy during positioning for spinal anesthesia, pain scores, and anesthesiologist comfort while administering spinal anesthesia. Methodology An observational study was conducted on patients of 40 to 80 years under the American Society of Anesthesiologists (ASA) physical status I-III, requiring hip surgeries under spinal anesthesia. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Pain score using the numeric rating scale (NRS) was recorded. Ultrasound-guided suprainguinal fascia iliaca block was performed using 30 ml of 0.25% levobupivacaine one hour before shifting to the operating room. Pain scores were reassessed. Spinal anesthesia was administered in the operating theatre in a sitting position. Pain during positioning was assessed. Results The mean NRS score reduced significantly after ultrasound-guided suprainguinal fascia iliaca block. The mean NRS score was 3.25 during positioning for spinal anesthesia compared to a pre-block score of 9.03, noting a statistically significant reduction (p=0.001). Conclusion Fascia Iliaca compartment block (FICB) helps alleviate the pain of hip fractures and makes positioning the subarachnoid block easier.

Evaluation of Safety of Spinal Anaesthesia in Patients Receiving Perioperative Antithrombotic Therapy Undergoing Infrainguinal Revascularisation Surgeries: A One-Year Prospective Clinical Research

Objective: To evaluate anaesthetic outcome, patient outcome and timing of perioperative antithrombotic therapy in relation to intrathecal injection in patients undergoing infrainguinal revascularisation surgery, for peripheral artery disease (PAD) in spinal anaesthesia.Material and Methods: A one-year prospective observational study was conducted; from May 2019 to May 2020, in a tertiary care centre. This included all consecutive patients undergoing infrainguinal revascularisation surgery for PAD under spinal anaesthesia. Preoperative antithrombotics were stopped, as per standard guidelines, to achieve a normal coagulation profile before spinal anaesthesia. Perioperative data related to the patients, antithrombotics, anaesthesia, surgery, and complications were recorded. Primary outcomes measured were anaesthetic outcome in terms of spinal success and spinal safety. Secondary outcomes measured were timing of perioperative antithrombotic therapy in relation to intrathecal injection and patient outcomes defined as: good, morbidity or mortality.Results: A total of 102 patients were evaluated, with a mean age of 54.69±16.36 years (91% males, 9% females): 58% had medical comorbidities. A single dose of intravenous (IV) unfractionated heparin (5,000-7,500 IU) was given intraoperatively at 24.97±3.69 minutes after intrathecal injection. Anaesthetic outcome was good in all patients; in terms of spinal safety (100%), as none of the patients developed spinal related complications. All had spinal success (100%), as no patient required conversion to general anaesthesia. Postoperatively, 98% (100) of patients had good outcomes, and mortality only occurred in 2% (2) of patients.Conclusion: Spinal anaesthesia is safe and effective for infrainguinal revascularisation surgery. If the patient has a normal preoperative coagulation profile, and the timeline to stop antithrombotic therapy is strictly followed, administration of IV unfractionated heparin (5,000-7,500 IU); at approximately 25 minutes after intrathecal injection, was found to be safe.

Spinal Versus General Anesthesia for Outpatient Total Hip and Knee Arthroplasty in the Ambulatory Surgery Center: A Matched-Cohort Study

BackgroundSpinal anesthesia is the predominant regimen in outpatient total joint arthroplasty (TJA), but induction often is unsuccessful, unobtainable, or against patient preference. We compared outcomes of same-day discharge (SDD) TJA with spinal versus general anesthesia in a free-standing ambulatory surgery center (ASC). MethodsWe took 105 general anesthesia TJA and one-to-one nearest-neighbor matched them to 105 spinal anesthesia TJA over 7 years at 1 ASC. The rate of successful SDD, minutes to discharge, postoperative pain and nausea, and 90-day complications were compared. Postanesthesia care unit outcomes were additionally stratified by spinal anesthetic (mepivacaine versus bupivacaine). ResultsAll spinal anesthetic patients underwent SDD compared with 103 (98%) general anesthetic patients (P = .498). Mepivacaine spinal anesthesia patients spent the fewest minutes in postanesthesia care unit prior to discharge from the facility (206), followed by general anesthesia (227), and bupivacaine spinal anesthesia (291; P < .001). General anesthesia patients had the highest levels of pain at 1 hour (5.2 versus 1.5 versus 1.5) and 2 hours (3.2 versus 2.0 versus 1.3) postoperatively, and rates of nausea (48 versus 22 versus 28%) compared with mepivacaine and bupivacaine spinal anesthesia, respectively. The 90-day complications (6 versus 7), admissions (1 versus 3), and reoperations (5 versus 2) were similar among spinal and general anesthesia, respectively (P ≥ .445). ConclusionsBoth spinal and general anesthesia led to reliable SDD with similar 90-day complication rates. General anesthesia facilitated faster discharge from the ASC compared with bupivacaine spinal anesthesia but led to higher levels of pain and incidence of nausea postoperatively. Level of EvidenceLevel 3, Retrospective Cohort Comparison.

Wipe Out Period of Spinal Anaesthesia in Patients of Hemorrhoidectomy in relation to Prakriti

Background: Surgical hemorrhoidectomy is most effective treatment for hemorrhoids. This procedure is commonly undertaken under spinal anaesthesia which produces intense sensory and motor blockade. In Clinical Practice of Anaesthesia, it is always seen that patients behave in a different manner even after the fact that they all are induced with similar anaesthetic agents with similar techniques of anaesthesia and maintained by similar anaesthetic agents. The difference in their behaviour is related to their physical, physiological and psychological status &amp; to evaluate this difference, present research work was done. The patients were posted for hemorrhoidectomy under LSAB injection Bupivacaine 0.5% as 12.5 mg (2.5ml) dose. Wipe out period checked after waning the effect of anaesthesia and onset of pain. Objectives: To evaluate the wipe out period of spinal anesthesia and studying its relation to different Doshaja Prakriti means how metabolism of the drug Bupivacaine is affected by specific Doshaja Prakriti of the human body. Materials and Methods: Clinical study has been accomplished by dividing patients in three groups i.e., Group I, Group II and Group III. Sample size - Total 60 patients. Intervention - Group I - Vata Pradhan, Group II - Pitta Pradhan, Group III - Kapha Pradhan. Results: Wipe out period of spinal anaesthesia is ~3-4 hrs in 85% patients belonged to Group I and ~4-5 hrs in 90% patients belonged to Group II while ~5-6 hrs in 70% patients belonged to Group III. Thus, it is concluded that wipe out period of spinal anesthesia of Vataj Prakriti is less than Pittaj and Kaphaj Prakriti. The intergroup difference was statistically highly significant at p&lt;0.001. Conclusion: The descriptions in Ayurveda indicates that individuals with Vata &amp; Pitta Prakriti are fast metabolizers while those of Kaphaj Prakriti are slow metabolizers, which may be comprehended to the extent.

The Effect of Preoperative Gabapentin on the Duration of Spinal Anaesthesia in Patients Undergoing Lower Limb Surgery: A Randomized Controlled Clinical Trial

Background: In the present study, we aim to examine oral gabapentin efficacy as an adjuvant to spinal anesthesia. Methods: This prospective, clinical, randomized trial included subjects between 20 and 60 years undergoing lower limb surgeries categorized into two cohorts. Group (G) received gabapentin (900 mg) in two divided doses prior to spinal anesthesia; (300 mg 10 hrs prior to spinal anesthesia induction as well as 600 mg 2 hrs before spinal anesthesia). In contrast, the control Group (C) received only spinal anesthesia. The onset, as well as the duration of spinal anesthesia, were the primary outcome, while the secondary outcome was the postoperative nalbuphine consumed. Results: A total of 60 cases were evenly categorized into two cohorts. Both groups demonstrated no differences regarding motor and sensory block onset and duration. The group receiving preoperative gabapentin had a significant decrease in postoperative nalbuphine consumption with a mean of 20.8±9.4 mg compared to the control group, which showed an increased consumption of 28.9±10.4 mg with a p-value of 0.006. Further analysis of the Visual Analog Score (VAS) in both groups revealed that the decrease in total nalbuphine consumption was found at (8 and 10 hrs) postoperatively, with p values of 0.016 and 0009, respectively. Conclusion: Gabapentin administration (900 mg) within 10 hrs of surgery in two subdivided doses prior to spinal anesthesia had no effect on onset and duration of spinal anesthesia but had a delayed beneficial postoperative analgesic effect. Clinical Trial Registration Number: This trial was registered at ClinicalTrials.gov (NCT05659810, URL: https://clinicaltrials.gov/ct2/show/NCT05659810in 21st December 2022.

PENGARUH TEKNIK RELAKSASI AUTOGENIK TERHADAP SKALA NYERI PADA PASIEN POST SPINAL ANESTESI DI RUMAH SAKIT PKU MUHAMMADIYAH GAMPING

If pain management is not optimal, it has detrimental consequences, which can cause disorders in the endocrine, metabolic, immune, and other body systems with clinical manifestations in the form of fever, hypertension, etc. Post spinal anesthesia pain is defined as pain experienced after post anesthesia anesthesia. Pain conditions often occur in post-cesarean section patients. One therapy that can reduce pain in post-spinal anesthesia patients is the autogenic relaxation technique. Autogenic relaxation is relaxation that comes from oneself which can calm the mind. The aim of this study was to determine the effect of autogenic relaxation therapy on the pain scale in post spinal anesthesia patients at PKU Muhammadiyah Gamping Hospital. This research design uses a pre-experimental design with one group pretest-post test design with the Wilcoxon test. The sample in this study was post spinal anesthesia patients aged 20-60 years, a total of 51 respondents using purposive sampling. Data were collected using the Numeric Rating Scale pain assessment sheet. The results obtained were the highest number of respondents based on the post spinal anesthesia pain scale before therapy, namely moderate pain of 47 respondents (92,2%) and severe pain of 4 respondents (7,8%), based on the post spinal anesthesia pain scale after therapy, namely mild pain of 12 respondents (23,5%), moderate pain was 35 respondents (68,6%), and severe pain was 4 respondents (7,8%). The results of the Wilcoxon sign rank test showed a p value of 0,001&lt;0,05. The conclusion of this study is that there is significant influence between autogenic relaxation techniques on the pain levels of post-spinal anesthesia patients at PKU Muhammadiyah Gamping.

Anesthetic efficacy and safety of ropivacaine 0.75% versus bupivacaine 0.5% for spinal anesthesia in patients undergoing lower limb orthopedic surgery

Background: Ropivacaine, a new amino-amide local anesthetic agent, is similar in chemical structure to bupivacaine. The low solubility of ropivacaine leads to greater sensory-motor differentiation by blocking sensory nerve fiber more readily than motor nervefibers. Early recovery of motor function is associated with decreased incidence of venous thromboembolism and early mobilization. Aims and Objectives: The present study aimed to compare the anesthetic efficacy and safety of hyperbaric ropivacaine 0.75% with hyperbaric bupivacaine 0.5% in spinal anesthesia in patients undergoing lower limb orthopedic surgery. Materials and Methods: A total of 60 patients aged between 18 and 60 years of either sex, ASA I and II, undergoing elective lower limb orthopedic surgery were randomly divided into two groups, ropivacaine (R) and bupivacaine (B) group. Group R received 3 mL of 0.75% hyperbaric ropivacaine and group B received 3 mL 0.5% hyperbaric bupivacaine intrathecally. The efficacy in terms of onset and duration of anesthesia, quality of anesthesia, and hemodynamic and safety in terms of complications were noted. Results: Group R produced faster onset of sensory block (ropivacaine 2.6±0.53 min; bupivacaine 3±0.56 min; P&lt;0.006) and the mean duration of sensory block was significantly lesser compared to Group B (Ropivacaine 121.16±7.73 min; Bupivacaine 180.34±11.56 min; P&lt;0.0001). Patients in Group R has significantly more rapid recovery of a motor blockade than Group B (ropivacaine 149.5±8.64 min; bupivacaine 210.17±13.19 min; P&lt;0.0001). Conclusion: Hyperbaric ropivacaine 0.75% was found to be a comparable alternative to hyperbaric bupivacaine 0.5% in patients undergoing lower limb orthopedic surgery.

The Prevalence of Acceptance Between General Anesthesia and Spinal Anesthesia Among Pregnant Women Undergoing Elective Caesarean Sections in Saudi Arabia.

Background The choice of anesthesia for an elective cesarean section should be based on an individual benefit-risk assessment, considering the pregnant woman's preferences, concerns, and the available medical expertise. This study aimed to determine the preferences for general and spinal anesthesia among women undergoing elective cesarean sections and the factors affecting their choice. Methods The study design is a cross-sectional study, and it was conducted on pregnant women to measure the acceptance of general anesthesia and spinal anesthesia in patients with elective cesarean sections in Saudi Arabia. Random pregnant women were invited to participate in this study across Saudi Arabia after fulfilling the inclusion criteria. A digital questionnaire was distributed across Saudi Arabia to be filled out by female residents. A Microsoft Excel (Microsoft Corporation, Redmond, Washington, USA) sheet was used for data entry, while IBM SPSS software version 27.0.1 (IBM Corp., Armonk, New York, USA) was used for statistical analysis. Results The study included 813 participants; most (28%) of them were 25-30 years old. Of the study participants, 54% had chosen spinal anesthesia before, 22% had chosen general anesthesia, and 24% had chosen neither. Reasons to choose general anesthesia were reported as follows: 21.6% feared pain during surgery, 24.2% feared watching the surgical procedures on their bodies, 16.6% feared back pain, 12.8% feared being paralyzed, and 15.1% feared needles used to administer anesthesia in the lower back. Reasons for choosing spinal anesthesia were reported as follows: 26.3% had back pain concerns; 13% feared prolonged unconsciousness; 9.6% feared having a headache after surgery; 17% had post-surgery pain concerns; 30.1% wanted to be alert at the time of the birth of the baby; 10.6% feared the chances of experiencing nausea and vomiting; and 7.4% feared not being able to breastfeed. Conclusion Spinal anesthesia was chosen by more participants than general anesthesia. There was a statistically significant association between choosing spinal anesthesia and the number of previous pregnancies, parity, history of preterm labor, and recommendation to undergo general or spinal anesthesia by non-medical staff. It was also significant with the older age and higher educational level of participants. This decision may be influenced by a number of variables, the most significant of which are prior experience with general anesthesia or spinal anesthesia, educational attainment, and non-medical advice.