COMPARISON BETWEEN UNILATERAL SPINAL ANESTHESIA AND CONVENTIONAL SPINAL ANESTHESIA IN ORTHOPEDIC LOWER LIMB OPERATION FOR HEMODYNAMIC STABILITY
Amir Murad Khudadad Boujan a and Bwar Ali Hussein b
a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
b Kurdistan Board of Medical Specialties, Sulaimani, Kurdistan Region, Iraq.
Submitted: 17/7/2019; Accepted: 17/2/2020; Published: 21/3/2020
DOI Link: https://doi.org/10.17656/jsmc.10243
A restricted sympathetic block when performing spinal anesthesia may lead to lower hemodynamic changes.
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.
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
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.
Unilateral spinal, Bupivacaine, Lower limb, Hemodynamics.
1. 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.
2. Di Cianni S, Rossi M, Casati A, Cocco. C, Fanelli G. Spinal anesthesia: An evergreen technique. Acta Biomedica. 2008; 79(1):9-17.
3. 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.
4. 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.
5. Picard J, Meek T. Complications of regional anaesthesia. Anaesthesia. 2010; 65(s1):105-115.
6. Faccenda KA, Finucane BT. Complications of regional anaesthesia: Incidence and prevention. Drug Saf. 2001; 24: 413-442.
7. 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.
8. 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.
9. 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.
10. Duke J. Spinal anesthesia. In: Duke J, Editor. Anesthesia Secrets. 4th ed. Elsevier ; 2011. p. 451-457.
11. 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.
12. Imbelloni LE, Beato L, Cordeiro JA. Unilateral spinal anesthesia with low 0.5% hyperbaric bupivacaine dose. Rev Bras Anestesiol. 2004;54(5):700-706.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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.
25. 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.
26. 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.
27. 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.
28. Neural Blockade in Clinical Anesthesia and Management of Pain. Anesth Analg. 1981;60(4):232-233.
29. Hocking G, Wildsmith JAW. Intrathecal drug spread. Br J Anaesth. 2004;93(4):568-578.
30. 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.
31. 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.
32. 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.
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.