A Comparative Study of Postoperative Early Ambulation with Intrathecal Morphine by 27-gauge Whitacre Needle and Bed Rest without Morphine by 25-gauge Quincke Needle / 대한마취과학회지

BACKGROUND: Early ambulation after anorectal surgery may be possible by relieving pain with intrathecal morphine and decreasing headache and backache with a much thinner and pencil-point needle. The difference in urinary peak flow rate in upright posture compared with recumbent position was reported to be highly significant, although acute urinary retention induced by intrathecal morphine may be decreased by early ambulation. METHODS: Eighty patients due for anorectal surgery were selected to receive spinal anesthesia. Subjects in group A (n=40) received 0.5% tetracaine 5 6 mg through a 25-gauge Quinke needle while group B (n=40) received 0.5% tetracaine 5 6 mg and intrathecal morphine 0.2 mg through a 27-gauge Whitacre needle. Postoperatively, group A received 24 hours bed rest and group B was recommended to walk as soon as possible. The duration of pain relief, onset time to ambulation, headache, backache, urinary retention and nausea were observed in both groups. RESULTS: The average onset time of early ambulation and duration of postoperative pain relief in group B was 3.6 +/- 1.0 and 15.1 +/- 3.5 hours respectively. The incidence of postspinal headache and backache was 2.5 and 5.0% in group B respectively and decreased significantly in comparison with group A (20.0 and 22.5%) respectively (P < 0.05). However, the incidence of postoperative nausea was 35.0% in group B and increased in comparison with group A (12.5%) (P < 0.05). Group B yielded a relatively lower urinary retention rate (40.0%) than group A (52.5%), but the difference did not reach statistical significance. CONCLUSIONS: Intrathecal morphine infused by a 27-gauge Whitacre needle provided postoperative pain relief with early ambulation, and decreased headache and backache, but we suggest that there is a need to select another drug or method instead of intrathecal morphine to decrease the incidence of urinary retention and nausea.

Care of the patient for surgery of large bowel

This paper deals with an established method of preparing patients for elective surgery of the large bowel, including the anorectum. Preoperative operation, which includes general and local measures, and postoperative care was discussed

Early Ambulation Reduces the Incidence of Urinary Retention after Spinal Anesthesia for Benign Anorectal Surgery / 대한마취과학회지

BACKGROUND: It has been known that bed rest after spinal anesthesia for benign anorectal surgery helps to reduce the incidence of postdural puncture headache, but the bed rest position is thought to have a negative effect on urinary retention, as a result of anxiety, anal distention, bladder distention and pain-induced reflex inhibition of the urinary bladder detrusor muscle. We investigate the effect of early ambulation after spinal anesthesia on postdural puncture headache and on urinary retention compared with bed rest for 24 hours. METHODS: One hundred and fifty-three ASA Physical Status I patients received spinal anesthesia for scheduled benign anorectal surgery. We applied hyperbaric 0.5% tetracaine 6 mg (1.2 ml) using 25 gauge Quincke needles with the cutting bevel parallel to the dural fibers at the patients' sitting position. All patients were randomly divided into an early ambulation group or bed rest group. We investigated the incidence of urinary retention and headache. The duration of operation, the perioperative intravenous fluid volume, surgical technique and postoperative pain regimen were standardized. RESULTS: The incidence of urinary retention in the early ambulation group (16/75, 21.3%) was lower than that in bed rest group (32/78, 41.0%). There was no difference in any parameters between the two groups. CONCLUSIONS: To reduce the incidence of urinary retention, early ambulation after spinal anesthesia for benign anorectal surgery is recommended over bed rest with no increase in the incidence of postdural puncture headache.

Effect of Patient Position with Spinal Anesthesia on the Heart Rate, Arterial Blood Pressure and Arterial Blood Gas Change / 대한마취과학회지

BACKGROUND: Anorectal procedures are performed in the prone jack-knife or lithotomy position. The effect of lithotomy and prone jack-knife position on the heart rate, arterial blood pressure and arterial blood gas has not been compaired. METHODS: 39 consecutive patients who underwent surgery for anorectal disease were performed saddle block. They were randomly classified into two groups: prone jack-knife position(J; n=19) and lithotomy position(L; n=20); patients with cardiovascular disease were excluded. The two groups were well matched for age, gender, weight and height. After spinal anesthesia, heart rate(HR), blood pressure(BP), and arterial blood gases(ABG) including pH, PaO2, PaCO2, HCO3- were measured in the supine position to establish a base line. After position change to either jack-knife or lithotomy, HR, BP(systolic, mean and diastolic) at 10, 20, and 30 minutes and ABG at 20minutes were measured again in each group. The two groups were then compared and any changes were recorded. Premedication was not perfomed in both group. Statistical analysis was performed by Mann-Whitney U test; significance was set at P <0.05. RESULTS: There were no differences between the two groups in terms of baseline HR, BP and ABG. However, HR at 10, 20 and 30 minutes after position change in the L group were increased compared with those of J group(deltaHR (number/minute) at 10 minutes: +3.2+/-7.0(L) versus - 2.8+/-4.9(J), P <0.05, 20 minutes: +5.6+/-7.4(L) versus - 1.8+/-5.2(J), P <0.05, 30 minutes: +6.4+/-8.4(L) versus - 1.2+/-6.0(J), p <0.05), and systolic BP at 30 minutes was increased in the J group(deltaBP: +4.0+/-9.0 mmHg(L) versus +10.1+/-9.9 mmHg(J), p <0.05). 3 patients in the J, and 2 in the L group had complaint of headache and/or upper arm discomfort. CONCLUSION: HR was increased in the lithotomy position, systolic BP at 30 minutes after position change was increased in the J group. But the differences were not so significant clinically. Another parameters were no differences between the two groups. Therefore there is no supiriority in lithotomy or jack-knife position on HR, BP and ABG when anorectal procedure is undergone under spinal anesthesia.