Continuous spinal anaesthesia using a standard epidural set for lower limb orthopedic procedures in high risk elderly patients

ABSTRACT

We studied 60 elderly Patients undergoing lower limb orthopedic procedures classified as ASA III or IV. Lumbar continuous spinal anaesthesia [CSA] was performed using a 20 G epidural catheter through an 18 G Tuohy needle. Small local anaesthetic boluses of isobaric bupivacaine [0.5%] was injected to achieve the desired sensory level of anaesthesia. Demographic data, anaesthetic duration, local anaesthetic doses, sensory level to pinprick, Arterial blood pressure, heart rate, use of systemic sympathomimetics and complications were recorded. Sensory level was between TB-T12, maximal decrease in systolic, diastolic BP and heart rate was 30 +/- 12.5%, 16.8 +/- 9.5% and 15.6 +/- 5.8% respectively. IV ephedrine used in 25% of our patients. While postdural puncture headache [PDPH] occurred in 1,66% of cases. No postanaesthetic neurological deficit was recorded. We conclude that CSA using a standard epidural set and isobaric bupivacaine is feasible for L.L. surgery in high-risk elderly patients