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177: Ambulatory inguinal hernia repair: paravertebral block versus spinal anesthesia
Posters
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Central Nerve Blocks
31
177. Ambulatory inguinal hernia repair: paravertebral block versus spinal anesthesia
209. Postoperative analgesia, side effects, and patient satisfaction after intrathecal diamorphine for total hip replacement
E.Y. Akcaboy, Z.N. Akcaboy, M. Baydar, N. Gogus Anesthesiology Department, Ankara Numune Research and Training Hospital, Ankara, Turkey
E. Vermani, S.Q. Tighe Department of Anaesthesia, The Countess of Chester Hospital, Chester, UK
Background: Inguinal herniorrhaphy (IH) is performed under various anesthetic techniques. The aim of study was to compare the effects of spinal anesthesia (SA) or paravertebral block (PVB) on the operating room efficiency and recovery.
Background: Intrathecal diamorphine provides effective analgesia (1). A high incidence of postoperative nausea, vomiting and pruritis has been reported (1), but this has not been our experience.
Methods: 48 patients undergoing IH were assigned into two groups, receiving SA (with levobupivacaine 0.5%, 3mL) or PVB (with levobupivacaine 0.5%, 5mL per each block). The PVB was performed unilaterally using a standard technique. Blocks were performed at five levels (T9-L1), and a total of 25mL levobupivacaine 0.5% with 1:400,000 epinephrine was given. SA was performed with a 25G Quincke needle at L3-L4 intervertebral space. Propofol infusion ([email protected]) .kg-1.min-1) was administered to all patients, which was titrated to light sleep with easy arousability for intraoperative sedation. Anesthesia related time [ART] (anesthesia preparation and immediate recovery time), fasttracking rate [FTR] (bypassed the phaseI recovery), home readiness [HR], patient satisfaction [PS] (1⫽excellent to 4⫽bad) and postoperative pain scores during 12h (low [L], moderate [M], high [H]) were compared between groups. Results were analyzed by Chi square and Student’s t tests with significance of p⬍0.05. Conclusion: Although performing PVB takes slightly more anesthesia related time, it seems more advantageous than SA because of shorter home readiness and better pain scores.
ART FTR HR PS (1,2,3,4) Pain Scores (L/M/H) *p ⬍ 0.05
Group SA (n ⫽ 23)
Group PVB (n ⫽ 25)
10.47 ⫾ 3.17 15 (%65) 240 ⫾ 96 12/9/2/0 7/14/2
13.28 ⫾ 4.59ⴱ 22 (%88) 156 ⫾ 60ⴱ 15/8/2/0 18/7/0ⴱ
Method: We followed up 76 patients for 24 hours after total hip replacement with spinal bupivacaine, diamorphine (0.25-1.0 mg, median 0.5 mg) and propofol sedation. Postoperatively, patients received 1g of paracetamol 6 hourly, ibuprofen 400 mg 6 hourly if not contraindicated and tramadol 50-100 mg 6 hourly as required. Cyclizine 50 mg 8 hourly and/or ondansetron 4mg 4 hourly were also prescribed as required. Patients were monitored according to a specific protocol on the orthopaedic ward. Pain was assessed four hourly (0,1,2,3; none, mild, moderate, severe). Results: Median pain scores: 0, 93%, 1, 7%. Maximum pain scores: 0, 38%, 1, 35%, 2, 17%, 3, 0%. Analgesic consumption: paracetamol alone, 13%, paracetamol and tramadol, 49%, paracetamol and ibuprofen, 14%, paracetamol, ibuprofen and tramadol, 16%, tramadol alone, 7%, none, 1%. 64% required up to 200mg tramadol, 7% 300mg and 1% 400mg. 17% were hypotensive. 7% had mild pruritis. 13% were nauseated at some point, 13% had one vomiting episode, 7% had 2 episodes and 4% had more than 2 episodes of vomiting. The total PONV incidence was 36%, but this was mostly mild nausea and/or only one vomiting episode. 86% of patients were very satisfied, 14% satisfied and none were dissatisfied. All would choose the same technique again. Conclusions: Intrathecal diamorphine is a simple, reliable technique that provides very good postoperative analgesia. Side effects included nausea, vomiting, hypotension and pruritis, but these are no worse than with other opiate related analgesic strategies. No other complications were noted and there was a high degree of patient satisfaction.
Reference 1. Barron DW, Strong JE. Postoperative analgesia in major orthopaedic surgery. Anaesthesia 1981;36:937-41.
•
Central Nerve Blocks
31
177. Ambulatory inguinal hernia repair: paravertebral block versus spinal anesthesia
209. Postoperative analgesia, side effects, and patient satisfaction after intrathecal diamorphine for total hip replacement
E.Y. Akcaboy, Z.N. Akcaboy, M. Baydar, N. Gogus Anesthesiology Department, Ankara Numune Research and Training Hospital, Ankara, Turkey
E. Vermani, S.Q. Tighe Department of Anaesthesia, The Countess of Chester Hospital, Chester, UK
Background: Inguinal herniorrhaphy (IH) is performed under various anesthetic techniques. The aim of study was to compare the effects of spinal anesthesia (SA) or paravertebral block (PVB) on the operating room efficiency and recovery.
Background: Intrathecal diamorphine provides effective analgesia (1). A high incidence of postoperative nausea, vomiting and pruritis has been reported (1), but this has not been our experience.
Methods: 48 patients undergoing IH were assigned into two groups, receiving SA (with levobupivacaine 0.5%, 3mL) or PVB (with levobupivacaine 0.5%, 5mL per each block). The PVB was performed unilaterally using a standard technique. Blocks were performed at five levels (T9-L1), and a total of 25mL levobupivacaine 0.5% with 1:400,000 epinephrine was given. SA was performed with a 25G Quincke needle at L3-L4 intervertebral space. Propofol infusion ([email protected]) .kg-1.min-1) was administered to all patients, which was titrated to light sleep with easy arousability for intraoperative sedation. Anesthesia related time [ART] (anesthesia preparation and immediate recovery time), fasttracking rate [FTR] (bypassed the phaseI recovery), home readiness [HR], patient satisfaction [PS] (1⫽excellent to 4⫽bad) and postoperative pain scores during 12h (low [L], moderate [M], high [H]) were compared between groups. Results were analyzed by Chi square and Student’s t tests with significance of p⬍0.05. Conclusion: Although performing PVB takes slightly more anesthesia related time, it seems more advantageous than SA because of shorter home readiness and better pain scores.
ART FTR HR PS (1,2,3,4) Pain Scores (L/M/H) *p ⬍ 0.05
Group SA (n ⫽ 23)
Group PVB (n ⫽ 25)
10.47 ⫾ 3.17 15 (%65) 240 ⫾ 96 12/9/2/0 7/14/2
13.28 ⫾ 4.59ⴱ 22 (%88) 156 ⫾ 60ⴱ 15/8/2/0 18/7/0ⴱ
Method: We followed up 76 patients for 24 hours after total hip replacement with spinal bupivacaine, diamorphine (0.25-1.0 mg, median 0.5 mg) and propofol sedation. Postoperatively, patients received 1g of paracetamol 6 hourly, ibuprofen 400 mg 6 hourly if not contraindicated and tramadol 50-100 mg 6 hourly as required. Cyclizine 50 mg 8 hourly and/or ondansetron 4mg 4 hourly were also prescribed as required. Patients were monitored according to a specific protocol on the orthopaedic ward. Pain was assessed four hourly (0,1,2,3; none, mild, moderate, severe). Results: Median pain scores: 0, 93%, 1, 7%. Maximum pain scores: 0, 38%, 1, 35%, 2, 17%, 3, 0%. Analgesic consumption: paracetamol alone, 13%, paracetamol and tramadol, 49%, paracetamol and ibuprofen, 14%, paracetamol, ibuprofen and tramadol, 16%, tramadol alone, 7%, none, 1%. 64% required up to 200mg tramadol, 7% 300mg and 1% 400mg. 17% were hypotensive. 7% had mild pruritis. 13% were nauseated at some point, 13% had one vomiting episode, 7% had 2 episodes and 4% had more than 2 episodes of vomiting. The total PONV incidence was 36%, but this was mostly mild nausea and/or only one vomiting episode. 86% of patients were very satisfied, 14% satisfied and none were dissatisfied. All would choose the same technique again. Conclusions: Intrathecal diamorphine is a simple, reliable technique that provides very good postoperative analgesia. Side effects included nausea, vomiting, hypotension and pruritis, but these are no worse than with other opiate related analgesic strategies. No other complications were noted and there was a high degree of patient satisfaction.
Reference 1. Barron DW, Strong JE. Postoperative analgesia in major orthopaedic surgery. Anaesthesia 1981;36:937-41.