Comparative evaluation of intrathecal minidose bupivacaine / fentanyl vs. conventional dose of bupivacaine for surgical repair of inguinal hernia in elderly patients

Spinal anesthesia is often used for surgical repair of inguinal hernia in the geriatric population. Intrathecal opioids enhance analgesia from subtherapeutic doses of local anesthetic and make it possible to achieve successful spinal anesthesia using otherwise inadequate doses of local anesthetic. This study was designed to investigate and compare whether a modification of the spinal anesthesia technique with addition of opioid to the injectate, combined with a reduction in the amount of bupivacaine versus conventional dose, could be effective procedure, with stable haemodynamics, maintain postoperative pain relief and reduce the recovery time, thus making spinal anesthesia more suitable for ambulatory inguinal herniorrhaphy. Forty patients ASA physical status I-III were classified into 2 equal groups. Group 1 received intrathecal bupivacaine 5 mg plus fentanyl 20microg. Group2 received intrathecal bupivacaine 15 mg only. Comparison of the 2 groups was in accordance to time of onset, level of sensory blockade, duration of analgesia, mean arterial blood pressure, heart rate, degree of pain sensation using visual analogue scale, intraoperative and postoperative nausea and vomiting, total amount of vasopressor used and time to recovery and home discharge. Our results showed that the time of onset of maximal blockade was slightly faster in the minidose group patients than the other group. The peak sensory level was higher in the conventional dose group patients. The conventional dose group patients were more likely to require treatment of hypotension than patients in the minidose bupivacaine-fentanyl group. Total amount of ephedrine requirements were in conventional dose group than the minidose bupivacaine-fentanyl group. Recovery and home discharge time was nonsignificantly prolonged in conventional dose group. Minidose of 5 mg bupivacaine in combination with 20 microg fentanyl provided spinal anesthesia for surgical repair of inguinal hernia in the elderly. The minidose combination caused dramatically less hypotension than 15 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure

Low-dose combined spinal epidural versus general anaesthesia for elective caesarean delivery: a comparative study

Combined spinal epidural [CSE] technique has allowed intrathecal doses of local anesthetic to be greatly reduced. Although regional anaesthesia is the preferred anaesthetic technique for caesarean section, general anaesthesia is still required in certain situations. The present study was designed to compare intraoperative haemodynamics, total ephedrine consumption, blood loss and postoperative analgesia of low-dose combined spinal epidural anesthesia with general anesthesia for uncomplicated elective caesarean delivery. Sixty ASAI parturients, with gestational age>36weeks with intrauterine single fetus scheduled for elective caesarean delivery. Patients were classified into 2 equal groups. Group 1: Low-dose Combined SpinAl Epidural Anaesthesia group [CSE]. Patients received subarachnoid 0.5% hyperbaric bupivacaine 6 mg mixed with fentanyl 20 micro g, and epidural 0.25% bupivacaine 10 mL. Group 2: General Anaesthesia group [GA]. Patients were induced by propofol, succinyl choline and atracurium with 50% nitrous oxide in oxygen and isoflurane 0.75%. After fetal delivery fentanyl was injected 1A micro g/kg, with with 60% nitrous oxide in oxygen and isoflurane 0.5%. There were nonsignificant differences regarding demographic data. Haemodynamic measurements showed nonsignificant changes in group1, while showed a significant increase in MABP and HR after induction and during extubation. There was a significant increase in total ephedrine consumption in group 1, while there was significant increases in blood loss, total amount of morphine consumption and VAS score in group 2. We conclude that low-dose combined spinal epidural anaesthesia is preferred to general anaesthesia for elective uncomplicated caesarean delivery with regard to haemodynamics, intraoperative blood loss and postoperative analgesia