Title: Comparative Evaluation of Classical Subarachnoid Block, Unilateral Subarachnoid Block and Low Dose Subarachnoid Block with Fentanyl in ASA III and ASA IV Patients Undergoing Lower Limb Surgeries
Authors: Dr Alladi Srikanth, Dr Pradeep Samuel Indurkar, Dr Manda H, Nagrale
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.67
Spinal anaesthesia is considered as a safe technique but can be detrimental to patients with hemodynamic instability. Safety improves if the block can be localized to the area of surgery. Patients with ASA3 and ASA4 grades are haemodynamically unstable. Hence an effective alternative may be unilateral subarachnoid block for lower extremity surgeries. Aim-to compare classical subarachnoid block(SAB) with unilateral SAB and low dose SAB. Method- 60 patients were divided in three groups. Control Group received 2ml of 0.5% Bupivacaine and turned to supine position immediately. STUDY Group I received 2ml of 0.5 % Bupivacaine and kept in lateral position for 10 minutes and then turned supine. STUDY Group II received 1.5 ml of 0.5 % Bupivacaine with 25 µg( 0.5 ml) Fentanyl and kept in lateral position for 10 minutes and then turned supine. Sensory blockade, motor blockade and haemodynamic parameters were studied. Results- Bradycardia and hypotension requiring treatment was less in both study groups. Unilateral spinal block and low dose spinal block induced lesser degree of motor blockade. There was no statistical difference in the onset time and duration of sensory and motor blockade among the 3 groups. Conclusion- we conclude that in high risk patients undergoing unilateral lower limb surgeries Unilateral low dose subarachnoid block offers better hemodynamic stability during the intra-operative period without affecting the quality of sensory and motor blockade Key words- Sabarachnoid block, unilateral block, low dose spinal, Bupivaicain. 1. Fanelli G, Torri G, Bilateral Versus unilateral selective subarachnoid anesthe-sia; cardiovascular homeostasis. Br J Anaesthesia.1996; 76; A242. 2. Imbelloni, Unilateral spinal anaesthesia with low0.5% hyperbaric bupivacaine dose.Rev.Bras.Anaesth.Vol.54.sep 2004. 3. Casati A, Fenelli G, et al. Effects of speed of intrathecal injection on unilateral spinal block. Minerva Anesth.1999; 65; 5-10. 4. Esmaoglu A, Karaoglu S, Mizrak A, Boyaci A. Bilateral vs unilateral spinal anaesthesia for outpatient knee arthroscopies. Knee Surg Sports Traumatol Arthrosc. 2003; 12:155–158. 5. Sotig D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. Anesth Analg. 2000; 91:876– 881. 6. Casati A, Fanelli G, Aldegheri G, et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med. 1999; 24:214–219. 7. Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Italian Study Group on Unilateral Spinal Anesthesia. Can J Anaesth. 2000; 47:746–751. 8. Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose response characteristics of spinal bupivacaine in volunteers. Clinical implications for ambulatory anest-hesia. Anesthesiology.1996; 85:729–736. 9. Chambers, WA Edstrim , HH , and Scott, DB , effect of baricity on spinal anaesth-esia with bupivacaine Br.J. Anaesth, 53 1981 53; 279. 10. Whiteside JB, Burke and Wildsmith AW. Spinal anaesthesia with ropivacaine 5mg ml in glucose 10 mg ml or 50mg ml. Brt Jour Anesth 2001; 86(2) 241-244 11. Kuusniemi KS, Pihlajamaki KK and Pitkanen MT. A low dose of plain or hyperbaric. Bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med 2004; 29 (1); 17-22. 12. Serpell MG, Gray W. Flow dynamics through spinal needles. Anesthsia 1997; 52:229-36. 13. Tecklenburg WE, Quest F, Nolte H and Meyer J. The effect of patient positioning on the spread of sensory blockade in hyperbaric and isobaric spinal anesthesia using bupivacaine. Reg Anaesth. 1990 ;13(7):163-7 14. Kristiina S, Kuusniemi MD, Kalevi K, Pihlajamaki and Mikko TP. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anes Anasthesiol Intensivmed Notfallmed Schmerzther. 2002; 37(11) ; 654 – 659 15. Povey H M R, Jacobsen J, et al. Subarachnoid analgesia with hyperbaric 0.5% bupivacaine: effect of a 60min period of sitting. Acta Anaesthesiol Scand 1989; 33; 295-7. 16. Frank A, Schuster M and Biscoping J. Influence of positioning on the quality of unilateral spinal anesthesia.Reg Anesth Pain Med. 2000; 25 (6); 605 – 610. 17. Dobrydnjov I, Axelsson K, Thorn S-E, et al. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesth Analg 2003;96:1496–503 18. Chohan U1, Afshan G, Hoda MQ, Mahmud S. Haemodynamic effects of unilateral spinal anesthesia in high risk patients. J Pak Med Assoc. 2002 Feb; 52(2):66-9. 19. Borghi B, Fanelli G, Cappelleri G, Casati A Borghi B, Cedrati V and Torri G. Low dose Hyperbaric bupivacaine for unilateral spinal anaesthesia. Can J Anaesth. 1998; 45(9):850-4.Abstract
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