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Single-dose spinal anaesthesia versus incremental dosing for lower limb vascular surgery
L Lundorff1, J O Dich-Nielsen, H Laugesen
1Department of Anaesthesia, Viborg Hospital, Denmark.
Acta Anaesthesiologica Scandinavica
|May 4, 1999
Summary
Single shot (SS) spinal analgesia and continuous spinal analgesia (CSA) showed similar hemodynamic responses in vascular surgery patients. SS is simpler and recommended for shorter procedures.
Area of Science:
- Anesthesiology
- Vascular Surgery
- Cardiovascular Research
Background:
- Atherosclerotic disease is common in vascular surgery patients.
- Spinal analgesia can cause significant hemodynamic changes in this population.
- No prior randomized studies compared single shot (SS) and continuous spinal analgesia (CSA) in vascular surgery.
Purpose of the Study:
- To compare the hemodynamic effects of SS versus CSA in patients undergoing vascular surgery.
- To evaluate postoperative outcomes including back pain, neurologic sequelae, and post-dural puncture headache (PDPH).
Main Methods:
- Prospective randomized study of 60 vascular surgery patients.
- Comparison of SS (17.5 mg bupivacaine) versus CSA (5 mg initial, 2.5 mg incremental doses).
- Invasive mean arterial pressure (MAP) monitoring and continuous ST-analysis; postoperative patient interviews.
Main Results:
- No significant differences in analgesic levels, MAP decrease, or ephedrine requirements between SS and CSA groups.
- More pronounced motor blockade in the SS group (P < 0.001).
- Lower total bupivacaine dose in CSA group (7.5 mg) vs. SS group (17.5 mg) (P < 0.001). One PDPH case, two instances of transient paresthesias per group.
Conclusions:
- No hemodynamic differences were observed between SS and CSA in leg vascular surgery patients.
- SS spinal analgesia is simpler to administer.
- SS is recommended when surgical duration is appropriate.