Spinal anesthesia versus general anesthesia with a laryngeal mask airway in patients undergoing radiofrequency ablation for varicose veins

Abstract

ÖZAmaç: Bu çalışmada variköz ven nedeniyle radyofrekans ablasyon yapılan hastalarda spinal anestezi ve larengeal maske hava yolu ile genel anestezinin etkinliği karşılaştırıldı.Ça lış ma pla nı: Mayıs 2012-Aralık 2016 tarihleri arasında larengeal maske hava yolu ile genel anestezi veya spinal anestezi altında radyofrekans ablasyon, varislerin çıkarılması ve perforan ven bağlanması yapılan toplam 2999 hasta (1067 erkek, 1932 kadın; ort. yaş 43 yıl; dağılım 19-70 yıl) retrospektif olarak incelendi. Hastanede yatış süresi, ameliyat sonrası Görsel Analog Ölçeği (GAÖ) skorları, hasta memnuniyeti, bulantı, kusma, boğaz ağrısı, baş ağrısı, sırt ağrısı ve üriner retansiyon dahil olmak üzere tıbbi kayıtlar kullanılarak veriler kaydedildi. Bul gu lar:Hastaların 2512'sine larengeal maske hava yolu ile genel anestezi ve 487'sine spinal anestezi uygulandı. Ortalama hastanede yatış süresi genel anestezi grubunda 10.7 saat ve spinal anestezi grubunda 22.5 saat idi ve bu fark istatistiksel olarak anlamlı idi (p<0.001). Ameliyat sonrası birinci saatteki ağrı skorları spinal anestezi grubuna kıyasla genel anestezi grubunda daha yüksekti (0.1±0.1 cm'ye kıyasla 1.7±0.1 cm) (p<0.001). Hasta memnuniyeti genel anestezi grubunda, spinal anestezi grubuna kıyasla, daha yüksekti (%92'ye kıyasla %97) (p<0.001). Kusma insidansı genel anestezi grubunda yüksek iken, bulantı, baş ağrısı ve üriner retansiyon insidansı spinal anestezi grubunda daha yüksek idi (tümü için p<0.001).So nuç: Radyofrekans ablasyon sırasında larengeal maske hava yolu, spinal anesteziye kıyasla, hastaların erken taburcu olmasını sağlar ve hasta memnuniyetini artırır; ancak kusma ve boğaz ağrısı gibi yan etkiler görülebilir. Spinal anestezi ameliyat sonrası ağrının azalması ile larengeal maske hava yolu ile genel anesteziden daha ilişkili olmasına karşın, bulantı, baş ağrısı ve üriner retansiyona neden olabilir.Anah tarsöz cük ler: Larengeal maske hava yolu; radyofrekans ablasyon; spinal anestezi. ABSTRACTBackground: This study aims to compare the efficacy of spinal anesthesia and general anesthesia with a laryngeal mask airway in patients undergoing radiofrequency ablation for varicose veins.

Hyperbaric Intrathecal Ropivacaine in Patients Undergoing Endovenous Laser Ablation (EVLA) – A Case Series

“…Though this technique has specific advantages such as anaesthetization of large areas of body surface, low incidences of bleeding, prolonged post-operative analgesia and early discharge (day care), multiple needle punctures, injection of local anaesthetic solutions through veins may induce considerable pain, chances of local anaesthesia toxicity especially [1,2] if bilateral limb surgery, prolonged duration resulting in patient discomfort and completeness of procedure may not be achieved especially if venous ligation or cryolaser therapy is required . The main criteria for selecting the anaesthetic method for EVLA is no delay in mobilization as delay in mobilization increases risk of deep vein thrombosis [2,3]. At our centre, most EVLA procedures are bilateral and combined with sclerotherapy and cryolaser or venous ligation procedures.…”

“…General anaesthesia has certain side-effects like nausea, vomiting, sore throat and muscle pain, needing ICU admission in patients with comorbidities [1]. Spinal anaesthesia offers better surgical conditions with immobile patients for long duration with added advantage of dilation of venous system that allows better detection of incompetent veins [3]. Main side effects of spinal block include post dural puncture, headache, hypotension, bradycardia, delayed mobilization and urinary retention [1,3,4].…”

“…Spinal anaesthesia offers better surgical conditions with immobile patients for long duration with added advantage of dilation of venous system that allows better detection of incompetent veins [3]. Main side effects of spinal block include post dural puncture, headache, hypotension, bradycardia, delayed mobilization and urinary retention [1,3,4]. There is need for venous loading with intravenous fluids to avoid hypertension which leads to urinary retention [4], the need for urinary catheterization which is accentuated due to almost 1 to 2 litres of fluid used tumescent fluid that later gets absorbed into the circulation.…”

“…The anaesthesia technique commonly used is tumescent local anaesthesia. Various anaesthesia methods such as general anaesthesia, epidural anaesthesia, unilateral spinal anaesthesia, femoral nerve block, sciatic nerve block and conscious sedation are used for EVLA [2,3]. The EVLA procedure may involve both the limbs, may need ligation of venous perforators and may extend into other added procedures like sclerotherapy, cryolaser ablation which may prolong the duration, hence the need for spinal or general anaesthesia [1,4].…”

Femoral nerve block versus spinal anesthesia in the treatment of saphenous vein ablation

“…[6] However, some complications such as numbness, urinary retention, post-dural puncture headache, nausea, vomiting or deep vein thrombosis until ambulation may occur due to spinal anesthesia. [7,8] In the present study, we aimed to compare periand postoperative effects, duration of motor block, hemodynamic parameters and patient satisfaction in spinal anesthesia and femoral nerve block in patients with venous insufficiency of lower extremity.…”