COMPARISON BETWEEN UNILATERAL SPINAL ANESTHESIA AND CONVENTIONAL SPINAL ANESTHESIA IN ORTHOPEDIC LOWER LIMB OPERATION FOR HEMODYNAMIC STABILITY

Authors

  • Amir Murad Khudadad Boujan Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
  • Bwar Ali Hussein Kurdistan Board of Medical Specialties, Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10243

Keywords:

Unilateral spinal, Bupivacaine, Lower limb, Hemodynamics

Abstract

Background 

A restricted sympathetic block when performing spinal anesthesia may lead to lower hemodynamic changes.

Objectives 

The aim of this study is to make a comparison between unilateral spinal anesthesia with conventional spinal block in orthopedic lower limb operation regarding hemodynamic stability and vasopressors use.

Materials and Methods

Hyperbaric bupivacaine 0.5% and 27G Quincke spinal needle were used for 42 ASA I and II patients, they were divided randomly into two groups; Unilateral block was performed with patients in sitting position, spinal needle were inserted, needle’s bevel faced to target side 1.5-2 ml of hyperbaric bupivacaine injected within 2 minutes, patient positioned at lateral position with target side downwards for 15 minutes then turned to supine position. Conventional spinal block performed with patients in sitting position, 2-2.5 ml of bupivacaine was injected, and then the patient shifted to supine position.

Results

Systolic and diastolic blood pressure readings at 5, 10, and 15 minutes after induction was significantly higher in unilateral group with more vasopressor use in bilateral group (p value = 0.02). No statistically significant deference regarding pulse rate and arterial oxygen saturation

Conclusion

Unilateral spinal anesthesia using slow, low flow and low volume method in lower limb orthopedic procedures is associated with better hemodynamic stability in comparison to conventional spinal block.

References

Moosavi Tekye SM, Alipour M. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery. Brazilian J Anesthesiol. 2014;64(3):173-176. DOI: https://doi.org/10.1016/j.bjane.2013.06.014

Di Cianni S, Rossi M, Casati A, Cocco. C, Fanelli G. Spinal anesthesia: An evergreen technique. Acta Biomedica. 2008; 79(1):9-17.

Habibi MR, Baradari AG, Soleimani A, Zeydi AE, Nia HS, Onagh N. Hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in coronary artery bypass graft surgery patients with low ejection fraction: A double-blind, Randomized, Clinical trial. J Clin Diagnostic Res. 2014; 8(10):1-5. DOI: https://doi.org/10.7860/JCDR/2014/10237.5006

Nordin P, Haapaniemi S, Van Der Linden W, Nilsson E. Choice of anesthesia and risk of reooperation for recurrence in groin hernia repair. Ann Surg. 2004; 240(1):187-192. DOI: https://doi.org/10.1097/01.sla.0000130726.03886.93

Picard J, Meek T. Complications of regional anaesthesia. Anaesthesia. 2010; 65(s1):105-115. DOI: https://doi.org/10.1111/j.1365-2044.2009.06205.x

Faccenda KA, Finucane BT. Complications of regional anaesthesia: Incidence and prevention. Drug Saf. 2001; 24: 413-442. DOI: https://doi.org/10.2165/00002018-200124060-00002

Canturk M, Kilci O, Ornek D, Ozdogan L, Pala Y, Sim O et al. Ropivacaine for Unilateral Spinal Anesthesia; Hyperbaric or Hypobaric? Rev Bras Anestesiol. 2012;62(3): 298-311. DOI: https://doi.org/10.1016/S0034-7094(12)70131-9

Kiasari AZ, Babaei A, Alipour A, Motevalli S, Baradari AG. Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial. Med Arch. 2017; 71(4):274-279. DOI: https://doi.org/10.5455/medarh.2017.71.274-279

Neal JM, Barrington MJ, Brull R, Hazdic A, Herbi JR, Horlocker TT, et al. The Second ASRA Practice Advisory on Neurologic Complications Associated with Regional Anesthesia and Pain Medicine: Executive Summary 2015. Reg Anesth Pain Med. 2015; 40(5):401-430. DOI: https://doi.org/10.1097/AAP.0000000000000286

Duke J. Spinal anesthesia. In: Duke J, Editor. Anesthesia Secrets. 4th ed. Elsevier ; 2011. p. 451-457. DOI: https://doi.org/10.1016/B978-0-323-06524-5.00066-0

Oliver J, Zeballos JL. Spinal Anesthesia. In Lind S, Robert W, Richard D, Editor. Essential Clinical Anesthesia Review: Keywords, Questions and Answaers for Boards. Cambridge University Press; 2015. p. 187-190. DOI: https://doi.org/10.1017/CBO9781139584005.058

Imbelloni LE, Beato L, Cordeiro JA. Unilateral spinal anesthesia with low 0.5% hyperbaric bupivacaine dose. Rev Bras Anestesiol. 2004;54(5):700-706. DOI: https://doi.org/10.1590/S0034-70942004000500013

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med. 2000; 25(6): 605-610. DOI: https://doi.org/10.1097/00115550-200011000-00010

Enk D, Prien T, Van Aken H, Mertes N, Meyer J, Brussel T. Success rate of unilateral spinal anesthesia is dependent on injection flow. Reg Anesth Pain Med. 2001;26(5): 420-427. DOI: https://doi.org/10.1097/00115550-200109000-00006

Povey HMR, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5 % bupivacaine: effect of a 60-min period of sitting. Acta Anaesthesiol Scand. 1989;33(4):295-297. DOI: https://doi.org/10.1111/j.1399-6576.1989.tb02911.x

Tiwari AK, Tomar GS, Agrawal J. Intrathecal bupivacaine in comparison with a combination of nalbuphine and bupivacaine for subarachnoid block: A randomized prospective double-blind clinical study. Am J Ther. 2013;20(6):592-595. DOI: https://doi.org/10.1097/MJT.0b013e31822048db

Russell IF. A comparison of cold, pinprick and touch for assessing the level of spinal block at caesarean section. Int J Obstet Anesth. 2004;13(3):146-152. DOI: https://doi.org/10.1016/j.ijoa.2003.12.007

Meyer J, Enk D, Penner M. Unilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle. Anesth Analg. 1996;82(6):1188-1191. DOI: https://doi.org/10.1097/00000539-199606000-00015

ApaydIn Y, Erk G, Sacan O, Tiryaki C, Taspinar V. Characteristics of unilateral spinal anesthesia at different speeds of intrathecal injection. J Anesth. 2011; 25(3):380-385. DOI: https://doi.org/10.1007/s00540-011-1111-x

Casati A, Fanelli G, Beccaria P, Alde gheri G, Beri M, Senatore R, et al. Block distribution and cardiovascular effects of unilateral spinal anaesthesia by 0.5% hyperbaric bupivacaine. A clinical comparison with bilateral spinal block. Minerva Anestesiol. 1998;64(7-8):307, 312.

Atef H, el-Din el-Kasaby A, Omera M, Badr M. Optimal dose of hyperbaric bupivacaine 0.5% for unilateral spinal anesthesia during diagnostic knee arthroscopy. Middle East J Anesthesiol. 2012;21(4):591-598.

Chohan U, Afshan G, Hoda MQ, Mahmud S. Haemodynamic effects of unilateral spinal anesthesia in high risk patients. J Pak Med Assoc. 2002;52(2):66-69.

Ozturk T, Cevikkalp E, Nizamoglu F, Ozbakkaloglu A, Topcu I. The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower Extremity. Turkish J Anesth Reanim. 2015;44(2):91-95. DOI: https://doi.org/10.5152/TJAR.2015.66933

Merivirta R, Kuusniemi K, Jaakkola P, Pihlajamäki K, Pitkänen M. Unilateral spinal anaesthesia for outpatient surgery: A comparison between hyperbaric bupivacaine and bupivacaine-clonidine combination. Acta Anaesthesiol Scand. 2009;53(6):788-793. DOI: https://doi.org/10.1111/j.1399-6576.2009.01955.x

Nauman Akhtar M, Tariq S, Abbas N, Murtaza G, Nadeem Naqvi SM. Comparison of haemodynamic changes in patients undergoing unilateral and bilateral spinal anaesthesia. J Coll Physicians Surg Pakistan. 2012;22(12):747-750.

Osinaike BB, Amanor-Boadu SD, Lawani-Osunde AS, Eyelade OR. Clinical comparison of cardiorespiratory effects during unilateral and conventional spinal anaesthesia. West Afr J Med. 2007;26(3):230-233. DOI: https://doi.org/10.4314/wajm.v26i3.28316

Kelly JD, McCoy D, Rosenbaum SH, Brull SJ. Haemodynamic changes induced by hyperbaric bupivacaine during lateral decubitus or supine spinal anaesthesia. Eur J Anaesthesiol. 2005;22(9):717-722. DOI: https://doi.org/10.1017/S0265021505001183

Neural Blockade in Clinical Anesthesia and Management of Pain. Anesth Analg. 1981;60(4):232-233. DOI: https://doi.org/10.1213/00000539-198104000-00019

Hocking G, Wildsmith JAW. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568-578. DOI: https://doi.org/10.1093/bja/aeh204

Janik R, Dick W, Stanton-Hicks M. The effect of the injection speed on the blockade characteristics of hyperbaric bupivacaine and tetracaine in spinal anesthesia. Reg Anaesth. 1989;12(4):63-68.

Stienstra R, Gielen M, Kroon JW, Van Poorten F, Van F. P. The influence of temperature and speed of injection on the distribution of a solution containing bupivacaine and methylene blue in a spinal canal model. Reg Anesth. 1990;15(1):6-11.

Casati A, Fanelli G, Aldegheri G, et al. Frequency of Hypotension During Conventional or Asymmetric Hyperbaric Spinal Block. Reg Anesth Pain Med. 1999;24(3):214-219. DOI: https://doi.org/10.1097/00115550-199924030-00006

Published

2020-03-21

How to Cite

1.
Boujan A, Hussein B. COMPARISON BETWEEN UNILATERAL SPINAL ANESTHESIA AND CONVENTIONAL SPINAL ANESTHESIA IN ORTHOPEDIC LOWER LIMB OPERATION FOR HEMODYNAMIC STABILITY. JSMC [Internet]. 2020 Mar. 21 [cited 2024 May 27];10(1):81-7. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10243

Similar Articles

1-10 of 67

You may also start an advanced similarity search for this article.