[Combined spinal-epidural and epidural anesthesia in operations on the vessels of the lower extremities]. / Kombinirovannaia spinal'no-épidural'naia i épidural'naia anesteziia pri operatsiiakh na sosudakh nizhnikh konechnosteii.

Eighty-eight anesthesias in patients operated on the lower limb vessels are analyzed. In group 1 (77 pts) combined spinal-epidural anesthesia (CSEA) was used, in group 2 (16 pts) epidural anesthesia (EA). Segmentary blocking was induced by 2% lidocaine and 0.5% bupivacaine. CSEA was characterized by a shorter (in comparison with EA) latent period (12.9 +/- 1.3 min vs. 24.7 +/- 3.4 min, p < 0.05), a lower dose of bupivacaine (lidocaine: 735 +/- 89 mg in CSEA and 848 +/- 92 mg in EA; bupivacaine: 28.3 +/- 7.2 mg in CSEA and 92.6 +/- 8.5 mg in EA, p < 0.01), and a higher reliability. Combined anesthesia with bupivacaine is characterized by a greater contribution of the spinal component (than with lidocaine) and thus improve the quality of anesthesia, decrease the anesthetic dose, and maintain the stability of hemodynamic parameters. Four cases with inadequate blocking were due to erroneous position of the epidural catheter. Accidental perforation of the dura mater occurred in two patients, and prolonged spinal anesthesia was carried out. No headaches ensued. Hence, CSEA should be preferred to common prolonged EA in operations on the lower limb vessels.