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Efficacy of Combined Spinal Epidural Block with Needle through Needle Single Interspace Technique and Epidural Anesthesia for Elective Infra Umbilical Orthopedic and Gynecological Surgery

Guralingappa C. Upase, Senior Specialist, Department of Anesthesiology, District Hospital Vijayapura, Vijayapura, Karnataka 586102, India. , Guralingappa C. Upase1 , Basavaraj N. Walikar2 , Anand N. Patil3 , N.R. Bhat4 , Ankush Pandit5

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Indian Journal of Anesthesia and Analgesia 5(8):p 1319-1323, August 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5818.11

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Abstract

Background: Over three decades revival interest developed in effective use of regional anesthesia techniques for surgery and pain management.

Objective: To evaluate the efficacy of combined spinal epidural block and epidural block.

Materials and Methods: Prospective study was conducted on American Society of Anesthesiologists grade I and II patients (20 to 60 years old) posted for infraumbilical gynecological and orthopedic surgeries. Sixty patients were randomized divided into two groups of 30 each such as group A (combined spinal epidural) and group B (epidural). Various parameters were studied to evaluate efficacy of combined spinal epidural anesthesia and epidural anesthesia regarding sensory blockade (by pinprick method), motor blockade (modified Bromage scale method) and total amount of bupivacaine required. Data was analyzed using unpaired t test and chi square test with the help of MS Excel and SPSS software.

Results: Onset of anesthesia (sensory blockade) in group A (combined spinal epidural) was reduced significantly (p<0.05) as compared to group B (Epidural). Extent of motor blockade, group A showed all patients had grade 3 blockade which was 100%, whereas grade 3 blockade was found in only 3 patients of group B which was 10% only. The total amount of bupivacaine required was less in group A when compared with group B.

Conclusion: Combined spinal epidural anesthesia showed effective and promising future over epidural anesthesia by offering rapid onset of action, superior quality of analgesia, better muscle relaxation and less dose of local anesthetic required.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5818.11

Keywords

Bupivacaine; Combined Spinal Epidural Block; Epidural Block; Needle Through Needle Technique; Neuraxial Blocks.

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