NEW TECHNIQUE OF COMBINED SPINAL-EPIDURAL ANESTHESIA IN LOWER LIMB SURGERY
Keywords:
Combined Spinal-Epidural Anesthesia;, Leakage of local anesthetics;, and Spinal needle stylet through Tuohy needle
Abstract
https://doi.org/10.31386/dmj.2019.13.1.2
Background:There are several theories to explain the action of local anesthetic in combined spinal-epidural anesthesia (CSE), this study is to examine a technique of (CSE) that depends on the theory of leakage of epidural drugs to the subarachnoid cerebrospinal fluid (CSF).
Patients and Methods:After approval of local medical ethics committee and obtaining informed consent, 60 patients (18-80 years, ASA physical status I to IV) who listed for orthopedic lower limb surgery under CSE were included in this study. The study design was prospective Cross-Section comparative one. It was done in Gulan General Hospital and Gian Private Hospital in Duhok Governorate in Kurdistan Region of Iraq in the period from 01/01/2017 to 28/2/2018.
Results:the volume needed to get maximum sensory block (MSB) and the frequency of top-up doses are greater in group A than B.The onset time of group A is longer than group B. The mean arterial pressure was much stable in group A with less nausea and vomiting in the same group. Addition, more patients in group A than group B were able to move against gravity.
Conclusions:the effect of this technique in combined spinal-epidural anesthesia can be compared to that of separate needle with more stable vital signs and less complications but with more allover doses of local anesthetics.
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References
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28. Chakravarthy M., Mattur K., Reddy K., Kumar S., Khaber S. Modified combined spinal and epidural anesthesia. Anesthesia and Intensive Care. 2008, v. 36(5):746-748.
29. Dresner M., Pinder A. Anesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath® spinal catheter. International Journal of Obstetric Anesthesia. 2009, 18(2): 131-136.
30. Iff I., Franz S., Moens Y. Measurement of the puncture profile and extradural pressure of cattle during extradural anesthesia. Veterinary Anesthesia & Analgesia. 2009, 36(5): 495–501.
31. Higuchi H., Takagi Sh., Onuki E., Fujita N., Ozaki M. Distribution of Epidural Saline upon Injection and the Epidural Volume Effect in Pregnant Women. Anesthesiology. 2011, 114(5): 1155-1161.
32. Okada K, Okada S, Nitshitani K. Effect of epidural pressure gradient on buprenorphine flux through the dural hole after combined spinal–epidural anesthesia. Comparison between bolus injection and continuous infusion. Masui. 1998, 47: 64–8.
33. Anthony Ch., Carolina B., Chuan-Chin H., Kelly E., Eric C, Julian R. et al. Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesthesia and Analgesia. 2017, 124(2): 560–569.
34. Wadlund D. L. Local Anesthetic Systemic Toxicity. Aorn Journal: 2017. v. 106(5): p 367-377.
35. Guo J., Sheng R., Yan Ch., Zhao Q., Wei Y., Cao Y. et al. Combined epidural/spinal anaesthesia with new needle-beside-needle technique for caesarean section: a randomized controlled trial. Int J Clin Exp Med. 2018, 11(7):6840-6847.
2. Lee R. A., Van Zundert A.A.J., Visser W. A., Lataster L. M. A., Wieringa P. A. Thoracic Combined Spinal-Epidural (CSE) Anaesthesia, Southern African Journal of Anaesthesia and Analgesia. 2008, 14:1, 63-69.
3. Koht A., Sloan T. B., Toleikis J. R. Monitoring the Nervous System for Anesthesiologists and Other Health Care Professional. 2011, 6: 115-36.
4. Loubert P., O’Brien R., Fernando N., Walton S., Philip T., Addei M., Columb O., et al. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial. Anesthesia 2011; 66(5): 341-347.
5. Foreman M. D., Milisen K, Fulmer T. T. Critical Care Nursing of Older Adults. 2010, Third Edition, 18; 363-404.
6. Jankovic D., Peng. P. Regional Nerve Block in Anesthesia and Pain Therapy. 2015, v. 43, no. 4, p. 576-81.
7. John J. Nagelhout, Karen L. Plaus. Technology related to anesthesia practice: Anesthesia Equipment: Nurse Anesthesia. 2014, v. 15, no. 5, p. 242-291.
8. Kodeih, M. G., Al-Alami A. A. , Atiyeh B. S., anazi G.E. Combined spinal epidural anesthesia in an asthmatic patient undergoing abdominoplasty: Plast.Reconstr.Surg. 2009, v. 123, no. 3, p. 118e-120e.
9. Miller R. D., Cohen N. H., Eriksson L. I., Fleisher L. A., Wiener-Kronish J. P., Young W. L. Spinal, Epidural, & Caudal Anesthesia: Epidural Anesthesia. 2014, Factors affecting the level of block. In 8th edition Miller's Anesthesia, no. 56, p. 1684-1720.
10. Suresh M., Fernando R., et al. Local Anesthetics in Obstetrics: Evidence-based Applications, Controversies, Toxicity and Current Therapies. Anesthesia for Obstetrics. 2013, 8, 9: 104-119.
11. Brenda A. Bucklin, David R. Gambling, David Wlody.: Impact of Analgesia on labor and Delivery Outcomes. A Practical Approach to Obstetric Anesthesia 2009, 12:169–184.
12. Stamenkovic D., Karanikolas M., Combined Spinal Epidural Anesthesia and Analgesia: a new "hanging drop": Epidural Analgesia – Current Views and Approaches. 2012, no. 8, p. 119-120.
13. Tsukada S., Wakui M., Hoshino A.Pain Control after Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial Comparing Periarticular Injection and Epidural Analgesia: JB & JS The journal of bone and joint surgery. 2015, v.97, no. 5, p. 367-373.
14. Saigal D., Wason R. Paramedian epidural with midline spinal in the same intervertebral space: An alternative technique for combined spinal and epidural anaesthesia: Indian J Anesth. 2013, v. 57, no. 4, p. 364-370.
15. Stamenkovic D., Geric V., Djordjevic M., Raskovic J., Slavkovic Z., Randjelovic T. et al. Subarachnoid morphine, bupivacaine and fentanyl as part of combined spinal-epidural analgesia for low anterior resection. A prospective, randomised, double-blind clinical trial: Anaesth.Intensive Care. 2009, v. 37, no. 4, p. 552-560.
16. Cook T. M., Counsell D., Wildsmith J. A. W. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists: British Journal of Anaesthesia 2009, v. 102, no. 2, p. 179-190.
17. Stamenkovic D. M., Geric V., Slavkovic Z., Raskovic J., Djordjevic M. Combined spinal-epidural analgesia vs. intermittent bolus epidural analgesia for pain relief after major abdominal surgery. A prospective, randomised, double-blind clinical trial: Int.J.Clin.Pract. . 2008, v. 62, no. 2, p. 255-262.
18. Todorov L., Boncouer T. V. Etiology and Use of the “Hanging Drop” Technique: A Review: Pain Research and Treatment. 2014, Article ID 146750, p. 1-10.
19. Magar J. S., Bawdane K. D., Patil R. Comparison of Efficacy and Safety of Unilateral Spinal Anaesthesia with Sequential Combined Spinal Epidural Anaesthesia for Lower Limb Orthopaedic Surgery: J Clin Diagn Res. 2014, v. 11, no. 7, p. 17-20.
20. Benhamoua D., Bertib M., Brodnerc G., De Andresd J., Draiscie G., Moreno-Azcoitaf M. et al. Postoperative Analgesic Therapy Observational Survey (PATHOS): A practice pattern study in 7 Central/Southern European countries: Pain. 2008, v. 136, no. 1-2, p. 134-141.
21. Amann M., Proctor L. T., Sebranek J. J., Eldridge M.W., Pegelow D.F., Dempsey J. A. Somatosensory feedback from the limbs exerts inhibitory influences on central neural drive during whole body endurance exercise: Journal of Applied Physiology. 2008, v. 105, no. 6, p. 1714-1724.
22. Soens M. A., Birnbach D. J., Ranasinghe J. S., Zundert A. V. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand. 2008, 52(1):9-19.
23. Karmakar M. K., Li X., Ho A. M.-H., Kwok W. H., Chui P. T. Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth. 2009, 102(6):845-854.
24. Van deVeldea M., Berendsa N., Kumara A., Devroea S., Devliegerb R., Vandermeerscha E. et al. Effects of epidural clonidine and neostigmine following intrathecal labor analgesia: a randomized, double-blind, placebo-controlled trial. International Journal of Obstetric Anesthesia. 2009, 18(3): 207–214.
25. Nadir Sh., Brendan C., Ashraf S. H., Lindsay B., Jill M. M., Pervez S. A Systematic Review Evaluating Neuraxial Morphine and Diamorphine-Associated Respiratory Depression After Cesarean Delivery. Anaesthesia & Analgesia. 2018, 127(6): 1385-1395.
26. Gupta D., Srirajakalidindi A., Soskin V. Dural Puncture Epidural Analgesia is not Superior to Continuous Labor Epidural Analgesia. M.E.J. Anaesth.2013, 22(3): 309–316.
27. Carvalho B. Respiratory Depression after Neuraxial Opioids in the Obstetric Setting. Anesthesia & Analgesia: September 2008, Volume 107 - Issue 3 - p 956-961
28. Chakravarthy M., Mattur K., Reddy K., Kumar S., Khaber S. Modified combined spinal and epidural anesthesia. Anesthesia and Intensive Care. 2008, v. 36(5):746-748.
29. Dresner M., Pinder A. Anesthesia for caesarean section in women with complex cardiac disease: 34 cases using the Braun Spinocath® spinal catheter. International Journal of Obstetric Anesthesia. 2009, 18(2): 131-136.
30. Iff I., Franz S., Moens Y. Measurement of the puncture profile and extradural pressure of cattle during extradural anesthesia. Veterinary Anesthesia & Analgesia. 2009, 36(5): 495–501.
31. Higuchi H., Takagi Sh., Onuki E., Fujita N., Ozaki M. Distribution of Epidural Saline upon Injection and the Epidural Volume Effect in Pregnant Women. Anesthesiology. 2011, 114(5): 1155-1161.
32. Okada K, Okada S, Nitshitani K. Effect of epidural pressure gradient on buprenorphine flux through the dural hole after combined spinal–epidural anesthesia. Comparison between bolus injection and continuous infusion. Masui. 1998, 47: 64–8.
33. Anthony Ch., Carolina B., Chuan-Chin H., Kelly E., Eric C, Julian R. et al. Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial. Anesthesia and Analgesia. 2017, 124(2): 560–569.
34. Wadlund D. L. Local Anesthetic Systemic Toxicity. Aorn Journal: 2017. v. 106(5): p 367-377.
35. Guo J., Sheng R., Yan Ch., Zhao Q., Wei Y., Cao Y. et al. Combined epidural/spinal anaesthesia with new needle-beside-needle technique for caesarean section: a randomized controlled trial. Int J Clin Exp Med. 2018, 11(7):6840-6847.
Published
2019-05-31
How to Cite
N. MOHAMMED, H., & M. HASSAN, W. (2019). NEW TECHNIQUE OF COMBINED SPINAL-EPIDURAL ANESTHESIA IN LOWER LIMB SURGERY. Duhok Medical Journal, 13(1), 9-21. Retrieved from https://dmj.uod.ac/index.php/dmj/article/view/68
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