Publication

Abstract : Context: With sequential combined spinal epidural anaesthesia the advantages of both spinal and epidural anaesthesia can be obtained avoiding many of the side effects of spinal anaesthesia. Aim of study: To compare efficacy and safety of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients undergoing major orthopaedic procedure. Material and methods: The study was a prospective, randomized comparative one conducted in 60 patients aged 65 to 80 years of ASA III and IV, posted for major orthopedic surgical procedures. Group A received sequential combined spinal epidural anaesthesia with 1 ml of 0.5% hyperbaric bupivacaine and 25 µ fentanyl spinally. Group B received spinal anaesthesia with 2 ml of 0.5% hyperbaric bupivacaine and 25µ fentanyl. In group A, 1.5-2 ml of 0.5% isobaric bupivacaine was given for every unblocked segment through epidural route to extend block to T10. In group B if after 10 to 15 min the block did not reach T10 sensory level, supplementation with general anaesthesia was given. Motor block of lower limbs was assessed bilaterally using Bromage Scale. Results: Onset of block(8.8±1.7 vs 10.4±1.7 min) and time to achieve Bromage I block (11.6±1.6 vs 12.9±1.8 min) were longer in CSEA group than spinal group. Level of block achieved was higher in spinal group compared to CSEA ( T6 vs T10). No significant difference was observed with duration of analgesia. There was significant fall in MAP in the spinal group in the initial 30 min. Conclusion: Sequential combined spinal epidural technique is effective and safe, with stable haemodynamics and prolonged analgesia compared to spinal anaesthesia in eriatric patients undergoing major orthopaedic surgery.