Anesthetic management of elderly women scheduled for vaginal hysterectomy

ABSTRACT

Our study was designed to suggest a safe regional anesthetic technique for elderly women undergoing vaginal hysterectomy suitable for the. duration of surgery, without the need for general anesthesia. Twenty patients scheduled for elective vaginal hysterectomy were randomly divided into two groups, spinal group [SG] and combined spinal epidural group [CSEG], with mean age [60.5 +/- 9.4, 63.2 +/- 3.6], respectively. In SG 2.5 mL hyperbaric bupivacaine 0.5% were injected into the subarachnoid space through 25-gauge spinal needle, in CSEG, 2.5mL hyperbaric bupivacaine 0.5% were injected into the subarachnoid space through 25-gauge spinal needle and bupivacaine 0.5% was injected epiduraly through an epidural catheter, with a total volume not exceeding 1215mL. The maximal sensory level achieved in CSEG, was significantly higher than that in SG. [median T3.6, maximum T3, minimum T4] versus [median T5.5, maximum T5, minimum T6] P < 0.05, Time [minuets] taken for the block to recede to T10 was significantly longer in CSEG compared with SG. [151.6 +/- 7.486] versus [119.2 +/- 10.25] p < 0.05. Maximum decrease in systolic blood pressure [%] was significantly higher in CSEG compared with SG, [22.4 +/- 5.9] versus [16.9 +/- 5] P < 0.05. The combined spinal epidural anesthesia provided a significantly higher level of sensory blockade and longer time for the block to recede to T10, compared with spinal anesthesia, which make CSE anesthesia the preferred technique to avoid the need for general anesthesia in elderly women undergoing vaginal hysterectomy