Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

Abstract

CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA) and combined spinal epidural anesthesia (CSE) are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING:Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto.METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH) were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated.RESULTS: Seven patients were excluded (three CSA and four CSE). There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA. CLINICAL TRIAL REGISTRATION NUMBER: NCT00616044RESUMO CONTEXTO E OBJETIVOS: Em cirurgias ortopédicas de grande porte, a raquianestesia contínua e o bloqueio combinado raqui-peridural são métodos seguros e confiáveis. Neste estudo prospectivo foram comparadas as propriedades e efeitos colaterais da raquianestesia contínua com o bloqueio combinado raqui-peridural de punção única em pacientes programados para cirurgia ortopédica de quadril, joelho e fraturas de fêmur. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, conduzido no Instituto de Anestesia Regional do Hospital de Base de São José do Rio Preto.MÉTODOS: 240 pacientes com cirurgias de quadril, artroplastia de joelho ou correção de fratura de fêmur programadas foram aleatoriamente arrolados para receberem raquianestesia contínua ou bloqueio combinado raqui-peridural (CSE). Os bloqueios foram realizados com o paciente na posição lateral no interespaço L3-L4. O sucesso das punções, dificuldades técnicas, parestesia, nível do bloqueio sensitivo e bloqueio motor, necessidade de doses complementares de anestésico local, grau de dificuldade técnica, alteração cardiociruculatória e cefaléia pós-punção foram registradas. Ao final da cirurgia, o cateter foi retirado e foi avaliado se havia refluxo de líquor. RESULTADOS:Sete pacientes foram excluídos (3 CSA e 4 CSE). H...

Comparison of unilateral spinal and continous spinal anesthesia for hip surgery in elderly patients

“…[51213] Clinical studies have shown that hemodynamic stability is greater with CSA than with other neuraxial anesthesia techniques,[123814] but limited studies have been published on this technique for elderly patients. Few studies or case reports[9101516] have evaluated the efficacy and safety of CSA in this population, probably because of concerns about potential adverse effects-principally neurologic complications and PDPH.…”

Haemodynamic effects of central neural blocks

“…The degree of the effect depends on the position of the patient's body, the type of surgery, the technique of anaesthesia.Severe hypotension is associated with high risk in case of advanced age, therefore the continuous spinal anaesthesia (CSA) is a well-established technique that has been used successfully in this group of patients. CSA is an effective technique in elderly patients undergoing lower extremity surgery (3,14). Imbelloni and co-workers found that the CSA technique compared with the CSE block is safer for high-risk patients with unstable haemodynamics because the injected dose of a local anaesthetic is lower, it gives better control of the level of blockade and shorter duration of arterial hypotension (14).…”

“…CSA is an effective technique in elderly patients undergoing lower extremity surgery (3,14). Imbelloni and co-workers found that the CSA technique compared with the CSE block is safer for high-risk patients with unstable haemodynamics because the injected dose of a local anaesthetic is lower, it gives better control of the level of blockade and shorter duration of arterial hypotension (14).…”

Efficacy of Unilateral Spinal Anaesthesia and Sequential Combined Spinal Epidural Anaesthesia for Surgery of Lower Limb - A Prospective and Comparative Study

“…But technical exertion in introduction of spinal catheters occurs, due to the likelihood of complication like Caudal Equina syndrome and Post Dural Puncture Headache (PDPH), thus limiting the technique. [9,10] We did not find any randomized studies in the literature comparing sequential CSEA with unilateral SA for lower limb orthopaedic surgery. The aim of giving unilateral SA is to bound dispersal of spinal block only to the operated side for unilateral lower limb interventions.…”