Continuous Spinal Anesthesia with a Microcatheter and Low-Dose Bupivacaine Decreases the Hemodynamic Effects of Centroneuraxis Blocks in Elderly Patients

Abstract

This prospective randomized study was designed to investigate the hemodynamic effects and quality of continuous spinal anesthesia (CSA) after rapid injection of a low dose of 0.5% bupivacaine through a 32-gauge microcatheter. The method was compared with continuous epidural (CEA) and single-dose spinal anesthesia (SSA). Seventy-seven elderly patients (ASA II-III) ranging from 57 to 94 yr old and undergoing lower limb surgery were assigned to CSA (n = 26), CEA (n = 26), and SSA groups (n = 25). In all three groups, mean arterial pressure (MAP) and heart rate (HR) were assessed continuously for 30 min after initial injection, as well as after every reinjection of local anesthetic in the CSA and CEA groups. Bupivacaine (0.5%) was used as a local anesthetic. The initial doses were 1 mL of CSA, 10 mL of CEA, and 3 mL of SSA. The reinjection doses were 1 mL of CSA and 5 mL of CEA. In the CSA group, MAP did not decrease, whereas in the CEA group, the maximum decrease was 15% +/- 3% (mean +/- SEM) for the initial injection, 12% +/- 2% for the first repetition, and 13% +/- 2% for the second repetition. In the SSA group, the largest decrease of MAP was 19% +/- 2%. All changes of MAP in the CEA and SSA groups were significantly larger compared with CSA group (P < 0.05). A total of seven patients in these two groups needed vasopressors due to a decrease of MAP of more than 30% from baseline values. Heart rate did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

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

“…In some other studies comparing CSA with other neuraxial techniques, the authors found less frequent and less pronounced decreases in MAP in the CSA groups. [24] In our study, MA P values were decreased in both groups, with the significant decrease occurring first at 30 min and at 90 min in the CSA and USA groups, respectively. In Bai et al .…”

“…[123] CSA allows titration of small amounts of local anesthetic to achieve the appropriate level and provide adequate duration of anesthesia with only minimal hemodynamic changes;[4] thus, minimizing the risks of cardiovascular and respiratory disturbances. [56] Primary indications for CSA in elderly and high-risk patients are lower abdominal and lower limb surgery.…”

Anesthetic Management for Lower Limb Fracture in Severe Aortic Valve Stenosis and Fat Embolism: A Case Report and Review of Literature

“…Several studies have reported improved hemodynamic control with continuous SA over epidural or single-dose SA in healthy patients (12-13). Collard et al utilized continuous SA in two patients with severe AS undergoing surgery on the lower extremities.…”

Continuous Spinal Anesthesia

“…16 In a comparison of CSA with SSA and CEA for lower extremity orthopedic surgery in elderly patients, mean arterial pressure did not change in the patients who had CSA, but in the CEA and SSA groups, mean arterial pressure dropped by 15% and 19%, respectively. 17 A recent study of elderly patients undergoing hip fracture repair compared CSA with low-dose bupivacaine SSA. In the SSA group, mean arterial pressure dropped by $30% in 51% of patients, while only 8% of patients with CSA exhibited such a change, despite receiving less ephedrine (11 mg with SSA versus 4.5 mg in CSA) to support blood pressure.…”