Continuous spinal anaesthesia: A retrospective analysis of 318 cases

Abstract

Background and Aims:Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety.Methods:This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications. Statistical analysis was done using Chi-square test.Results:Three hundred and eighteen patients (94%) successfully underwent surgery using CSA. Twenty cases (6%) had failed CSA, of which five of them had CSA insertion failure, while the rest failed to complete the operation under CSA, thus requiring conversion to general anaesthesia. Patients who have had an initial intrathecal local anaesthetic (LA) volume ≥1.5 ml had higher odds (odds ratio (OR) 2.78; 95% confidence interval [CI], 1.70–4.57) of developing hypotension compared to those who had <1.5 ml (P < 0.001). There were no reported post-dural puncture headache, neurological sequelae or infection.Conclusion:CSA is a useful anaesthetic technique with low failure rate. The key to achieving haemodynamic stability is by giving a small initial bolus, then titrating the block up to required height using aliquots of 0.5 ml of intrathecal LA through the catheter.

Anaesthesia of pregnant women

“…Remifentanil (PCA-R) -a short-acting opioid with a metabolism independent of the liver and kidneys -has turned out to be particularly useful recently. Provides quick analgesia with high satisfaction of the giving birth compared to other opioids, the comparison with EA or CSE is lower in this analysis; in addition, PCA-R increases the risk of maternal apnea, desaturation, nausea, vomiting and sedation, without reducing the Apgar score below seven in the fifth minute in neonates compared to EA, and the risk of cesarean delivery is comparable to EA/CSE [26]. In the RESPITE study, the object was to compare the effectiveness of the analgesic effect of PCA-R (40 ug bolus on demand, 2 min.…”

Awake Da Vinci robotic partial nephrectomy: First case report ever in a situation of need

“…Many complications of CSA have been reported, including post-dural puncture headache, bleeding and epidural hematoma, infection, inadvertent catheterization of the subdural space, inadequate anesthesia and catheter breakage during removal. 5 In our case, none of these complications occurred. We acknowledge that the choice of an awake robotic surgery is hardly generalizable.…”

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

“…CSA can be technically challenging; with an incidence of 0-4.3% of facing difficulty while inserting a 20G catheter, however, we did not find such difficulty. [ 8 ]…”