Transient neurologic symptoms following spinal anesthesia with isobaric mepivacaine: A decade of experience at Toronto Western Hospital

Background: Transient neurologic symptoms (TNSs) can be distressing for patients and providers following uneventful spinal anesthesia. Spinal mepivacaine may be less commonly associated with TNS than lidocaine; however, reported rates of TNS with intrathecal mepivacaine vary considerably. Materials and Methods: We conducted a retrospective cohort study reviewing the internal medical records of surgical patients who underwent mepivacaine spinal anesthesia at Toronto Western Hospital over the last decade to determine the rate of TNS. We defined TNS as new onset back pain that radiated to the buttocks or legs bilaterally. Results: We found one documented occurrence of TNS among a total of 679 mepivacaine spinal anesthetics (0.14%; CI: 0.02–1.04%) that were performed in 654 patients. Conclusion: Our retrospective data suggest that the rate of TNS associated with mepivacaine spinal anesthesia is lower than that previously reported in the literature

Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. RESULTS: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness. CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting

Relationship of abdominal circumference and trunk length with spinal anesthesia block height in geriatric patients undergoing transurethral resection of prostate

Introduction: Spinal anesthesia is commonly used for various surgical procedures. Prediction of spinal anesthesia block height is always a challenging task for anesthetists. Higher than desired levels of spinal anesthesia blocks are associated with serious side effects, while inadequate block height does not provide satisfactory surgical anesthesia. In this study, we observed the relationship between the ratio of trunk length (TL) and square of the abdominal circumference (AC2) and spinal anesthesia sensory block height in geriatric patients undergoing transurethral resection of the prostate (TURP). Material & Methods: This is a cross-sectional study conducted at the Aga Khan University Hospital Karachi, Pakistan, on geriatric patients undergoing TURP under spinal anesthesia. Forty-three elderly patients (American Society of Anaesthesiology level I-III) between 60 and 80 years were recruited for the study. In hospital wards, trunk length (TL) and abdominal circumference were recorded before the procedure. In the operating rooms, spinal anesthesia was performed at L3-L4 intervertebral space with 0.5% hyperbaric bupivacaine 10mg (2mls). Block height was measured by the placement of ice pads at different dermatomes. Spearman rank correlation coefficient was used to analyze the physical parameters (TL/AC2) and spinal anesthesia block height. Results: The ratio of trunk length and square of the abdominal circumference (TL/AC2) correlates with spinal anesthesia block height in geriatric patients, where the spearman rank correlation coefficient was r =-0.284 with p = 0.015. Conclusion: The ratio of the long axis (TL) and transection area of the abdomen (AC2), which coincides with (TL/AC2), correlated with spinal anesthesia sensory block height. Hence, elderly patients with a low TL/AC2 ratio will have higher block height after spinal anesthesia

The Effect of Intravenous Lidocaine on QTc Changes During Spinal Anesthesia in Elderly Patients

Prolonged QT interval may lead to serious arrhythmias and ventricular fibrillation, hence prevention of the QT-interval prolongation is crucial for physicians. The aim of this study was to assess the influence of intravenous lidocaine on the QTc interval resulting from spinal anesthesia with bupivacaine. In a randomized double blind trial, fifty male patients with mean age of 70.38 and ASA physical status ΙΙ, who underwent spinal anesthesia for elective orthopedic lower limb surgical procedures, were assessed. Our subjects were divided into two groups, patients randomly received intravenously either 1.5 mg/kg lidocaine 2% as test group (n=25), or 0.05 ml/kg isotonic sodium chloride as control group (n=25), just before inducing of spinal anesthesia. Spinal anesthesia was performed in the sitting position with 3 ml of 0.5% hyperbaric bupivacaine. Values of the QTc interval, heart rate, and arterial blood pressure were measured before spinal anesthesia as well as 1, 5, 15, and 30 minutes after spinal anesthesia. With respect to the within-group values, statistically significant prolongation of the QTc interval as well as hemodynamic variability were detected in the measured times after blockade. There was no statistical difference between two groups according to hemodynamic parameters and the duration of the QTc interval before spinal anesthesia and times after spinal block with bupivacaine. Administration of intravenous lidocaine may not prevent the prolongation of the QTc interval and hemodynamic changes resulting from spinal anesthesia with hyperbaric bupivacaine, in elderly subject

General Versus Spinal Anesthesia: Which is a Risk Factor for Octogenarian Hip Fracture Repair Patients?

SummaryBackgroundMost studies have shown no difference between the two types of anesthesia administered to hip fracture patients. This study compared postoperative morbidity and mortality in octogenarian patients who received either general or spinal anesthesia for hip fracture repair.MethodsWe retrospectively analyzed the hospital records of 335 octogenarian patients who received hip fracture repair in our teaching hospital between 2002 and 2006. A total of 167 and 168 patients received general and spinal anesthesia, respectively. Morbidity, mortality, and intraoperative and preoperative variables were compared between groups.ResultsThere were no mortality differences between spinal and general anesthesia groups. However, the overall morbidity was greater in the general anesthesia group than in the spinal anesthesia group (21/167 [12.6%] vs. 9/168 [5.4%]; p = 0.02). Respiratory system-related morbidity was also higher in the general anesthesia group than in the spinal anesthesia group (11/167 [6.6%] vs. 3/168 [1.8%]; p = 0.03). Logistic regression analysis revealed two significant predictors of postoperative morbidity: anesthesia type (general; odds ratio, 2.39) and preexisting respiratory diseases (odds ratio, 3.38).ConclusionGeneral anesthesia increased the risk of postoperative morbidity in octogenarian patients after hip fracture repair, and patients with preexisting respiratory diseases were especially vulnerable. Spinal anesthesia is strongly recommended in such individuals

A Quality Improvement Initiative Regarding Ondansetron in the Prevention of Spinal Anesthesia-Induced Hypotension

Spinal anesthesia is an excellent choice as the primary anesthetic for lower abdominal, perineal, and lower extremity procedures. Spinal anesthesia boasts several distinct advantages over general anesthesia. However, it is important to note that spinal anesthesia does not come without risk. The most common adverse reaction of spinal anesthesia is hypotension. Anesthesia providers use several methods to combat the hypotension that is so commonly associated with spinal anesthesia. One emerging trend to prevent spinal anesthesia-induced hypotension (SAIH) is the administration of ondansetron, a serotonin 5-hydroxytryptamine3 antagonist. Evidence has shown that the administration of ondansetron just prior to spinal anesthesia administration may decrease the prevalence of SAIH by blocking the serotonin receptors in the heart, thus preventing the triggering of the Bezold-Jarisch Reflex, a triad of hypotension, bradycardia, and peripheral vasodilation. Despite the mounting evidence supporting the use of ondansetron to prevent this phenomenon, it has not been widely adopted as the standard of care. The purpose of this project was to translate evidence-based anesthesia care of patients undergoing spinal anesthesia into practice by increasing anesthesia provider knowledge regarding the efficacy of pre-spinal anesthetic ondansetron in attenuating SAIH. An educational in-service was delivered to anesthesia providers at a 292 private-bed community hospital in West Virginia regarding the efficacy of ondansetron in the mitigation of SAIH in an attempt to increase provider knowledge about the usefulness of this intervention. Nineteen anesthesia providers took part in the in-service. Pre- and post-intervention Likert surveys were delivered that assessed the providers’ knowledge regarding the intervention, current use of the intervention in his or her practice, and willingness to adopt the intervention if sufficient evidence supports the change. It was concluded that the in-service increased provider knowledge regarding the use of ondansetron in the attenuation of SAIH and influenced an intended change in provider practice. Continuing education should be utilized to inform the evolution of evidence-based practice in anesthesia

General versus Spinal Anesthesia: Comparison of Complications and Outcomes in Lumbar Laminectomy Surgery

Background: This study was designed to compare the complications and outcomes of lumbar laminectomy surgery performed by general and spinal anesthesia. Methods: In this prospective study, 110 patients with two common degenerative spinal diseases (lumbar discopathy and spinal canal stenosis) were enrolled. All the patients were operated in Bahonar hospital, Kerman City, Iran, via either spinal or general anesthesia by a unique surgeon. Intraoperative and postoperative complications and outcomes were compared between the two groups using descriptive and analytic statistics methods. Results: Surgeon satisfaction of anesthesia, blood loss, and admission time were not statistically significant between the groups. But, postoperative pain at recovery room, and 1, 2, and 12 hours after the operation was significantly higher in general anesthesia compared to lumbar anesthesia. Morphine request was also significantly higher with general anesthesia (P < 0.001). Conclusion: This study demonstrates that general anesthesia has greater pain in comparison with spinal anesthesia that should be considered in degenerative spinal diseases surgeries. Keywords Laminectomy; Lumbar region; surgery; General anesthesia; Spinal anesthesi

Laparoscopic cholecystectomy under spinal-epidural anesthesia versus general anaesthesia: a prospective randomized study

Background: The choice between spinal-epidural anesthesia and general anesthesia for laparoscopic cholecystectomy depends on various factors, including patient characteristics, surgical team expertise, and institutional guidelines. While both techniques have their advantages and disadvantages, spinal-epidural anesthesia offers an alternative to general anesthesia, potentially reducing complications and improving patient outcomes. Objective of the study was to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. Methods: This study was conducted at Sheikh Hasina Medical College, Hobiganj, Bangladesh. In this prospective comparative study, we enrolled one hundred patients diagnosed with symptomatic gallstone disease and classified as American Society of Anesthesiologists (ASA) status I or II. These patients were subjected to randomization, with fifty of them assigned to undergo laparoscopic cholecystectomy under spinal anesthesia, while the remaining fifty received general anesthesia. Subsequently, we conducted a comprehensive assessment, comparing various intraoperative parameters, postoperative pain levels, incidence of complications, recovery rates, and patient satisfaction during the follow-up period, with the aim of evaluating the differences between these two anesthesia methods. Results: All the procedures were completed by the allocated method of anesthesia, as there were no conversions from spinal to general anesthesia. Pain was significantly less at 4 hours (p&lt;0.001), 8 hours (p&lt;0.001), 12 hours (p&lt;0.001), and 24 hours (p=0.02) after the procedure for the spinal anesthesia group compared with those who received general anesthesia. There was no difference between the 2 groups regarding complications, hospital stay, recovery, or degree of satisfaction at follow-up. Conclusions: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.

Evaluation of the Relationship of Low Back Pain with Spinal Anesthesia and its Related Factors in Patients Undergoing Urological Surgery

Background: Spinal anesthesia is the common method in outpatient surgeries, which has complications such as back pain. We aimed to evaluate the relationship between low back pain (LBP) with spinal anesthesia and its related factors in patients undergoing urological surgery. Materials and methods: In this cross-sectional study, 1000 patients undergoing urological surgery were enrolled. The severity of LBP was measured using the VAS (visual analog scale) pain on the 1st day, the 1st week, and the 1st month postoperatively. Patients’ age, sex, and the duration of surgery were collected. data analysis was performed using SPSS software, version 17. Results: Of the 1000 patients undergoing urological surgery, 636 (63.6%) patients and 364 (36.5%) patients underwent spinal and general anesthesia, respectively. In patients under general anesthesia, the LBP prevalence was higher than in patients under spinal anesthesia on the 1st week and the 1st month after surgery (P&lt;0.05). So, the LBP prevalence was as follows: on the 1st day (general anesthesia: 14.5% vs spinal anesthesia: 24.1%, p=0.09), at the 1st week (general anesthesia: 24.9% vs spinal anesthesia:13.5%, P=0.001) and the1th month (general anesthesia: 13.8% vs spinal anesthesia: 4%, P=0.001). On 1st day and 1st week after surgery, the rate of LBP was significantly higher in the &gt;45-year age group than in the age group less than 45 years (P&lt;0.05). The pain rate was higher in patients who had surgery duration of more than 2.5 hours in all three time periods (P=0.001). Conclusion: Although the LBP prevalence on 1st day after surgery in patients undergoing urological surgeries under spinal anesthesia was higher than in patients who underwent general anesthesia, there was a significant decrease in pain levels during the first week and month following the surgery in patients under spinal anesthesia. Older age and longer duration of surgery were related factors to pain

Faktor Faktor yang Mempengaruhi Terjadinya Shivering pada Pasien Pasca Spinal Anestesi

This study aims to determine the factors that influence the incidence of shivering in patients after spinal anesthesia. The method used was a systematic review of the incidence of shivering after spinal anesthesia. The results of this study show that spinal anesthesia causes shivering, which is influenced by the height of the spinal block, age, gender, length of operation, and body mass index (BMI). In conclusion, there is a relationship between age, gender, duration of surgery, body mass index (BMI), and the incidence of shivering in post-spinal anesthesia patients. All of these factors are related to each other. &nbsp; Keywords: Shivering, Spinal Anesthesi