Spinal Anesthesia

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In this study, we compared the safety and efficacy of continuous spinal anesthesia using Spinocath versus continuous epidural anesthesia in high-risk elderly patients undergoing major orthopedic lower limb surgeries. One of the finding of the present study is that the performance time of CEA was significantly shorter than that of CSA; there was greater difficulty in catheter introduction and subsequent extraction of the introducing needle in the CSA group. This finding is not consistent with the findings from other studies done by Sutter and colleagues [10], Klimscha and colleagues [11], as well as Parthasarathy and Ravishankar [12]. this because in CSA group of these studies the Tuohy needle was advanced directly until cerebrospinal fluid…show more content…
However, this statistically significant decrease is not clinically significant as the maximum decrease in MAP below the baseline values was less than 30%. The latter is less the 33% suggested by Mikko (2009) as the point below which hypotension is clinically significant and necessitates treatment. When the two groups were compared to each other, the maximum decrease in the MAP was more in the CEA group and this statistically significant. This is consistent with the findings from other studies done by Sutter and colleagues (1989) as well as Denny and Selander (1998) where the decrease in blood pressures was less in CSA so that cardiovascular stability was easily achieved. The height of the block is best controlled by titration of intermittent injections of a small volume of local anesthetic through the catheter with assessment of block level after each injection, so CSA (with titration by intermittent injections of small volumes of local anesthetic) seems to be a valuable method for anesthetic management of patients who either will not tolerate the administration of large amount of fluids or in whom the use of sympathomimetic for correction of spinal block induced hypotension should be avoided (Schnider et al, 1993). In the present study, there were no statistical significant in…show more content…
Manifestations of cauda equina syndrome are asymmetric weakness in legs, severe radicular pain in the back, thighs or legs or loss of sensation in the saddle area and/or bladder or bowel or sexual dysfunction (Rigler et al, 1991). Most of the reports of cauda equina syndrome following spinal anesthesia have been associated with use of both microcatheters which are caudally positioned and hyperbaric highly concentrated local anesthetics (in particular, hyperbaric 5% lidocaine and less commonly tetracaine) (Horlocker et al, 1997). The most likely cause is mal-distribution of the local anesthetic, following a slow injection through a small end-hole catheter. Hyperbaric solutions of local anesthetics are not preferred in CSA and especially not hyperbaric Lidocaine (Gielen, 1999). In the present study, where macrocatheters and isobaric bupivacaine are used, there were no neurological sequelae (motor, sensory or autonomic dysfunction) in any of the patients. Thus, CSA when correctly used is a safe
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