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Free Papers
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Central Nerve Blocks
123. Bupivacaine or ropivacaine in unilateral spinal anesthesia for day case surgery? Fabris1,
Golubovic2
L. Kalagac V. [email protected] 1Department of Anesthesia and ICU, General Hospital Pula, Pula, Croatia, 2Clinic of Anesthesia and ICU, Clinical Hospital Rijeka, Rijeka, Croatia Introduction: We compared the haemodinamics changes,the level of the block,and the potential side effects of low dose hyperbaric bupivacaine (B)versus low dose hyperbaric ropivacaine (R) in attemping to obtain a unilateral spinal anesthesia in patient undergoing elective surgery. Methods: 40 patients, ASA I,II,III, were randomly allocated to two groups to receive either hyperbaric bupivacaine 5mg ⫹25mg fentanyl or hyperbaric ropivacaine 5mg ⫹25mg fentanyl. After punction at L2-L3 / L3-L4 interspace,by the Whitacre needle the patient remained in the lateral position for some time. The degree of the spinal block was assessed by pin prick and Bromage score and compared beetwen the operated and non-operated sides. Premedication,haemodinamic monitoring BP,HR,SatO2, fluid rehidration, use of vasoactive drugs was standardized. Results: Mean time spent in the lateral position for (B):15⫹/ ⫺2min, for (R): 7⫹/⫺2 min before turning supine and starting the operation that last for 76⫹/⫺16min in the bupivacain,and 68⫹/ ⫺17min in the ropivacain group.Degree of the spinal block by Bromage score at the start of operation was 96%(B),and 86% the (R), but at the end of operation 31%(B)-partial motoric regression, 5% (R)complite motoric regression.The extension of sensory block was similary but the decrease was more than 2 dermatoms in the (R), and only for 1dermatom for(B). The mean time for the walk out was for the (B) 237⫹/⫺88 min,and for the (R) was 163⫹/⫺42 min. Hypotension was present: (B)-4,and (R)- 2 patients, bradicardia was more pronounced in ropivacain group (R)-7 /(B)-3patients. Inside that time all the patient had the first urine pass done. In the (R) 5 patient reported about short-acting pruritus around the navel during the surgery time. Conclusion: Hyperbaric ropivacaine provided significantly shorter time to surgery readiness,and significantly shorter time to home readiness, so this is the reason why it is more suitable for outpatient surgery.
173. Laproscopic cholecystectomy under spinal anaesthesia D.K. Singh [email protected] Anaesthesiology, I.M.S., B.H.U., Varanasi, India Introduction: Till date people could only think of general anaesthesia for laparoscopic cholecystectomy with the exception of few instances where regional anaesthesia has been tried as alternative approach. Laparoscopic cholecystectomy was tried before in epidural anaesthesia in pregnant patients in third trimester, in patients with cystic fibrosis, patients with chronic respiratory disease. It has been tried under spinal anaesthesia as pilot study. But the number of patients was less.. Our aim is to establish the idea of another alternative approach for this procedure with some great advantages. Method We conducted the feasibility of the procedure in 30 ASA grade I and II patients. Method: Thirty patients [3 male] who were suffering from chronic cholecystitis and cholelithiasis were given spinal anaesthesia. All received injection ondansetron 100microgram/kg, injection midazolam 0.05mg/kg and injection fentanyl 2microgram/kg intravenously. Spinal anaesthesia was given using 25G spinal needle in the L3-L4 intervertebral space using 3.0 ml of 0.5% heavy bupivacaine. Pneumoperitoneum was created with carbon-di-oxide insufflation. ECG, Heart Rate, Respiratory Rate, Pulse Oximetry, Blood pressure ABG were monitored. Results: All the patients were successfully operated without conversion into general anaesthesia. Eight patients complained about shoulder tip (right) pain which was relieved with fentanyl. Conclusion: therefore spinal anaesthesia can be good alternative approach for laparoscopic cholecystectomy with reduced expenditure, early ambulation and well patient comfort ness and satisfaction. Conclusion: Therefore spinal anaesthesia is a very good alternative choice if the patients conditions permits. It decreases the total cost to be beard by the patient. It decreases the duration of stay in PACU, allows early discharge and ambulation and avoids the complications related to general anaesthesia. Though it requires skilled surgeon. Informed consent regarding the conversion of the procedure into general anaesthesia is required.
Free Papers
•
Central Nerve Blocks
123. Bupivacaine or ropivacaine in unilateral spinal anesthesia for day case surgery? Fabris1,
Golubovic2
L. Kalagac V. [email protected] 1Department of Anesthesia and ICU, General Hospital Pula, Pula, Croatia, 2Clinic of Anesthesia and ICU, Clinical Hospital Rijeka, Rijeka, Croatia Introduction: We compared the haemodinamics changes,the level of the block,and the potential side effects of low dose hyperbaric bupivacaine (B)versus low dose hyperbaric ropivacaine (R) in attemping to obtain a unilateral spinal anesthesia in patient undergoing elective surgery. Methods: 40 patients, ASA I,II,III, were randomly allocated to two groups to receive either hyperbaric bupivacaine 5mg ⫹25mg fentanyl or hyperbaric ropivacaine 5mg ⫹25mg fentanyl. After punction at L2-L3 / L3-L4 interspace,by the Whitacre needle the patient remained in the lateral position for some time. The degree of the spinal block was assessed by pin prick and Bromage score and compared beetwen the operated and non-operated sides. Premedication,haemodinamic monitoring BP,HR,SatO2, fluid rehidration, use of vasoactive drugs was standardized. Results: Mean time spent in the lateral position for (B):15⫹/ ⫺2min, for (R): 7⫹/⫺2 min before turning supine and starting the operation that last for 76⫹/⫺16min in the bupivacain,and 68⫹/ ⫺17min in the ropivacain group.Degree of the spinal block by Bromage score at the start of operation was 96%(B),and 86% the (R), but at the end of operation 31%(B)-partial motoric regression, 5% (R)complite motoric regression.The extension of sensory block was similary but the decrease was more than 2 dermatoms in the (R), and only for 1dermatom for(B). The mean time for the walk out was for the (B) 237⫹/⫺88 min,and for the (R) was 163⫹/⫺42 min. Hypotension was present: (B)-4,and (R)- 2 patients, bradicardia was more pronounced in ropivacain group (R)-7 /(B)-3patients. Inside that time all the patient had the first urine pass done. In the (R) 5 patient reported about short-acting pruritus around the navel during the surgery time. Conclusion: Hyperbaric ropivacaine provided significantly shorter time to surgery readiness,and significantly shorter time to home readiness, so this is the reason why it is more suitable for outpatient surgery.
173. Laproscopic cholecystectomy under spinal anaesthesia D.K. Singh [email protected] Anaesthesiology, I.M.S., B.H.U., Varanasi, India Introduction: Till date people could only think of general anaesthesia for laparoscopic cholecystectomy with the exception of few instances where regional anaesthesia has been tried as alternative approach. Laparoscopic cholecystectomy was tried before in epidural anaesthesia in pregnant patients in third trimester, in patients with cystic fibrosis, patients with chronic respiratory disease. It has been tried under spinal anaesthesia as pilot study. But the number of patients was less.. Our aim is to establish the idea of another alternative approach for this procedure with some great advantages. Method We conducted the feasibility of the procedure in 30 ASA grade I and II patients. Method: Thirty patients [3 male] who were suffering from chronic cholecystitis and cholelithiasis were given spinal anaesthesia. All received injection ondansetron 100microgram/kg, injection midazolam 0.05mg/kg and injection fentanyl 2microgram/kg intravenously. Spinal anaesthesia was given using 25G spinal needle in the L3-L4 intervertebral space using 3.0 ml of 0.5% heavy bupivacaine. Pneumoperitoneum was created with carbon-di-oxide insufflation. ECG, Heart Rate, Respiratory Rate, Pulse Oximetry, Blood pressure ABG were monitored. Results: All the patients were successfully operated without conversion into general anaesthesia. Eight patients complained about shoulder tip (right) pain which was relieved with fentanyl. Conclusion: therefore spinal anaesthesia can be good alternative approach for laparoscopic cholecystectomy with reduced expenditure, early ambulation and well patient comfort ness and satisfaction. Conclusion: Therefore spinal anaesthesia is a very good alternative choice if the patients conditions permits. It decreases the total cost to be beard by the patient. It decreases the duration of stay in PACU, allows early discharge and ambulation and avoids the complications related to general anaesthesia. Though it requires skilled surgeon. Informed consent regarding the conversion of the procedure into general anaesthesia is required.