The Effect of Spinal versus General Anesthesia on Postoperative Pain and Analgesic Requirements in Patients Undergoing Peripheral Vascular Surgery

The optimal anesthetic technique for peripheral vascular surgery remains controversial. The purpose of this study was to evaluate the effect of spinal versus general anesthesia on postoperative pain, analgesic requirements and postoperative comfort in patients undergoing peripheral vascular surgery. A total of 40 patients scheduled for peripheral vascular surgery were randomly assigned to two groups of 20 patients each to receive general anesthesia (GA) or spinal anesthesia (SA). In GA group, anesthesia was induced using thiopental and fentanyl. Vecuronium was used for muscle relaxation. Anaesthesia was maintained with isoflurane and nitrous oxide. In the SA group, hyperbaric 0.5% bupivacaine was injected into the subarachnoid space. Postoperative pain was assessed for 24 hours by a visual analog scale during three assessment periods: 0–4, 4–12 and 12–24 h as well as analgesic requirements. Patients were also asked to assess their postoperative state as satisfactory or unsatisfactory with regard to the pain, side effects and postoperative nausea and vomiting. Visual analogue scale (VAS) pain score was significantly lower in the group SA compared with group GA. This effect was mainly due to the lower pain score during the first study period. The patients received general anesthesia also reported a significantly higher rate of unsatisfactory postoperative comfort than those receiving spinal anesthesia. We conclude that spinal anesthesia is superior to general anesthesia when considering patients’ satisfaction, side effects and early postoperative analgesic management

The Effect of Spinal versus General Anesthesia on Postoperative Pain and Analgesic Requirements in Patients Undergoing Peripheral Vascular Surgery

The optimal anesthetic technique for peripheral vascular surgery remains controversial. The purpose of this study was to evaluate the effect of spinal versus general anesthesia on postoperative pain, analgesic requirements and postoperative comfort in patients undergoing peripheral vascular surgery. A total of 40 patients scheduled for peripheral vascular surgery were randomly assigned to two groups of 20 patients each to receive general anesthesia (GA) or spinal anesthesia (SA). In GA group, anesthesia was induced using thiopental and fentanyl. Vecuronium was used for muscle relaxation. Anaesthesia was maintained with isoflurane and nitrous oxide. In the SA group, hyperbaric 0.5% bupivacaine was injected into the subarachnoid space. Postoperative pain was assessed for 24 hours by a visual analog scale during three assessment periods: 0–4, 4–12 and 12–24 h as well as analgesic requirements. Patients were also asked to assess their postoperative state as satisfactory or unsatisfactory with regard to the pain, side effects and postoperative nausea and vomiting. Visual analogue scale (VAS) pain score was significantly lower in the group SA compared with group GA. This effect was mainly due to the lower pain score during the first study period. The patients received general anesthesia also reported a significantly higher rate of unsatisfactory postoperative comfort than those receiving spinal anesthesia. We conclude that spinal anesthesia is superior to general anesthesia when considering patients’ satisfaction, side effects and early postoperative analgesic management

Bilirubin and liver enzymes assessment.

<p>Bilirubin and liver enzymes were measured (means ± SD) in untreated 24 h-short bowel-rats (SBS) and those administered diclofenac (D, 12 mg/kg intraperitoneally). BPC 157 (Bμ and Bn, 10 μg/kg and 10 ng/kg, respectively), L-NAME (N, 5 mg/kg), and L-arginine (A, 100 mg/kg) were administered alone or combined and controls were administered equivolume saline (5 mL/kg) intraperitoneally. *P<0.05, at least, vs. control.</p

Liver lesion assessment II.

<p>Liver lesion assessment revealed necrosis, steatosis, and congestion and was scored as 0–3 (min/med/max), cell nuclei diameters (μm), area of cell cytoplasm (μm²), double nuclei cell number (means ± SD) in untreated 24 h-short bowel-rats (SBS) and those administered diclofenac (D, 12 mg/kg intraperitoneally). BPC 157 (Bμ and Bn, 10 μg/kg and 10 ng/kg, respectively), L-NAME (N, 5 mg/kg), and L-arginine (A, 100 mg/kg) were administered alone or combined while controls were administered equivolume saline (5 mL/kg) intraperitoneally. *P < 0.05 vs. control.</p

Microscopy and gross anastomosis assessment (min/med/max)(days) in short bowel-rats and in short bowel-rats that received diclofenac (12 mg/kg intraperitoneally).

<p>Microscopy and gross anastomosis assessment (min/med/max)(days) in short bowel-rats and in short bowel-rats that received diclofenac (12 mg/kg intraperitoneally).</p

Brain lesion evaluations.

<p>Brain lesions were assessed in short bowel rats administered diclofenac (D, 12 mg/kg), saline 5 mL/kg, or BPC 157 (10 μg/kg) intraperitoneally. Characteristic presentation of hippocampal (HC and HB) and cerebellar nuclear (CC and CB) lesions are shown. Left upper panel (control, HC) shows severe edema and neuronal damage (gray arrow indicates ballooned; black, edematous; and white, normal neurons); right upper panel (BPC 157, HB) shows less edema and neuronal damage (gray arrow indicates ballooned; black, edematous; and white normal neurons). Cerebellar nuclei, lower panel (control (HC) shows severe edema and neuronal damage (gray arrow indicates ballooned; black, edematous; and white normal neurons); right lower (BPC 157, HB) shows less edema and neuronal damage (gray arrow indicates ballooned; black, edema; and white, normal neurons), H&E, 40×.</p