Hemodynamic Stability and Clinical Outcomes: A Comparative Study of Sequential Combined Spinal-Epidural versus Spinal Anesthesia in Lower Limb Surgery
Abstract
Background and Objectives: A common anesthetic method for lower limb procedures is spinal anesthesia. When haemodynamic changes do occur, they can be abrupt and harmful, especially in older people. Furthermore, spinal anesthesia has a finite duration. As a result, sequential combined spinal epidural (SCSE) anesthesia is becoming a safer method. The method combines the advantages of the two. To assess how the use of spinal anesthesia and SCSE block affects hemodynamic parameters during lower limb procedures. Methods: The study was conducted on 60 patients in the department of anesthesia from June 2022 to June 2023. A computer-generated number was used to randomly assign the patients to two groups of thirty each; the observations were made by an anesthetist who was not associated with the research. The study included ASA Grade I and II patients (male or female, 18–60 years old) who had posted for lower limb surgery with a maximum 2-hour surgical length. Results: 1 in group I, the number of patients who achieved T6 were 53% and in group II it was 20%, (p<0.05) was statistically significant. In group I the number of patients which achieved T8 were 27% and in group II it was 30%, (p>0.05). In group I, five patients had vomiting as against one patient in group II had vomiting p>0.05. The incidence of bradycardia and hypotension in either group was comparable. Conclusion: Sequential combined spinal epidural block maintains hemodynamic stability with minimal complications as compared to spinal anaesthesia.Keywords:
pre-anaesthetic examination, Sequential spinal epidural, Spinal, Haemodynamics, Side effectsReferences
1. Sharma K, Chari P, Gupta S. Combined spinal anaesthesia for lower limb orthopaedic procedures. J Anaesth Clin Pharmacol 1994; 10:257-260.
2. Vercauteren M. Twenty years of clinical use of combined spinal epidural anaesthesia: The evolution equipment. Clinical dialogues on regional anaesthesia 2002; 17:1-4.
3. Rajan S, Seetharaman M, Nair SG. Comparison of efficacy and safety of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients. Amrita J Anaesth 2014; 1-44.
4. Fan S-Z,Susetio I, Wan Gyp, Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for caesarean section – a balance block technique. Anaesth Analg 1994; 78:474-477.
5. Hamdani GA, Chohan U, Zubair NA. Clinical usefulness of sequential combined spinal epidural anaesthesia in high risk geriatric patients for major orthopaedic surgery. J Anesth Clin Pharmacol 2002; 18(2):163.
6. Blumgart CH, Ryall D, Dennison B, Thompson Hill LM. Mechanism of extension of spinal anaesthesia by extradural injection of local anaesthetic. Br J Anaesth 1992; 69:457-460.
7. Bhattacharya D, Tewari I, Chowdhuri S. Comparative study of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients for major orthopaedic surgery. Indian J Anaesth 2007; 51(1):32-36.
8. Okasha MM, Kamal S, Ramzy. An epidural volume extension with saline in combined spinal epidural anaesthesia for dynamic hip screw surgeries using low dose of intrathecal hyperbaric bupivacaine. Ain-Shams. J Anaesthesiol 2014; 7:350-355.
9. Tummala V, Rao LN, Vallury MK, Sanapala A. A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint. Anesth Essays Res 2015; 9(2):185-188.
10. Gupta P, Dua CK, Verma UC, Saxena KN, Chakraborty I. Sequential combined spinal epidural versus epidural anaesthesia in orthopaedic and gynaecological surgery. A comparative study. Indian J Anaesth 2002; 46:453-456.
11. Mutahar SA, Madhavi S, Unmesh S, Swati K, Somika A. Comparison of sequential combined spinal epidural anaesthesia and spinal anaesthesia in lower limb surgery: A prospective randomised double blind study. Indian J Clin Anaesth 2019; 6(1):66-70.
Published
Abstract Display: 0 
PDF Downloads: 0 
