Continuous Spinal Anesthesia with Spinocath® Catheter. A Retrospective Analysis of 455 Orthopedic Elderly Patients in the past 17 years

Abstract

Background and Objectives: Database analysis in general cost less and require less time as compared to large randomized controlled trials. This retrospective study with a catheter outside the cutting-tip needle for continuous spinal anesthesia for femur and hip surgery in elderly patients from 1998 to 2015, with the aim of determine possible advantages and disadvantages of this technique.Methods: Anesthetic records of 455 patients receiving continuous spinal anesthesia over a 17-year period were analyzed retrospectively. All blockades were performed with patients in the left lateral position and by the two authors. Doses of 0.5% isobaric bupivacaine were administered according to the patient's height. Evaluated parameters were: puncture success, highest level of anesthesia, lower limb motor block, quality of anesthesia, need for additional doses, failures incidence, paresthesia, postdural puncture headache, cardiovascular changes, mental confusion and delirium, blood transfusion and mortality.Results: Seven patients were excluded for failure to puncture and accidental perforation of the duramater. The mean time for puncture and placement of the catheter was 2.66±1.03 min. The kit was easy to use in 376 patients and difficult in 42 patients. In all patients the catheter was inserted from 1 to 2 cm in the subarachnoid space. The mode of dispersion cephalad analgesia was T12. In 360 patients, the initial dose was sufficient to reach T12 and 88 patients required to supplement the dose. Mean isobaric bupivacaine initial dose was 7.74±1.78 mg and total dose was 8.58±2.60 mg. Hypotension occurred in 32 patients and bradycardia in 21 patients. Low intensity headache lasting for 3 days has been observed in seven patients. There has been no cauda equina syndrome or transient radicular irritation. Mental confusion occurred in 29 patients. Conclusions:Our results with 455 patients over 17 years suggest that continuous spinal anesthesia with the catheter outside the needle for elderly orthopedic patient's shows minor insertion problem, a low incidence of hypotension, paresthesia and headache. No neurological complications were observed, such as cauda equina syndrome or transient neurological symptoms.

Spinal Anesthesia: Much More Than Single Shot of Hyperbaric Bupivacaine

“…In a recent retrospective article in continuous spinal anesthesia (CSA) with 455 orthopedic patients performed between 1998 and 2015, using a catheter outside the cutting-tip needle shows minor insertion problem, showed a low incidence of hypotension, paresthesia and headache [57]. No neurological complications were observed, such as cauda equina syndrome or transient neurological symptoms.…”

“…The main advantage of CSA is the possibility to gradually inject the local anesthetic and control dispersion in the CSF, providing security and control over the needs of each patient. Unfortunately, the manufacturer discontinued this catheter and we anesthetists have lost an excellent product in our therapeutic arsenal [57].…”

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“…In a recent retrospective article in continuous spinal anesthesia (CSA) with 455 orthopedic patients performed between 1998 and 2015, using a catheter outside the cutting-tip needle shows minor insertion problem, showed a low incidence of hypotension, paresthesia and headache [57]. No neurological complications were observed, such as cauda equina syndrome or transient neurological symptoms.…”

“…The main advantage of CSA is the possibility to gradually inject the local anesthetic and control dispersion in the CSF, providing security and control over the needs of each patient. Unfortunately, the manufacturer discontinued this catheter and we anesthetists have lost an excellent product in our therapeutic arsenal [57].…”