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Comparative study of two protocols of small-dose bupivacaine spinal anaesthesia for urologic surgery in elderly
20
Posters
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Central Nerve Blocks I
39. Efficacy of low-dose intrathecal morphine in urologic surgery Kaabachi O Hoˆ pital Sahloul, Sousse, Tunisia Background and aim of the study: Low-dose of intrathecal morphine was associated with a prolonged and an effective analgesia. The dose of 0,1 mg was the optimal dose with minimal unpleasant side effects.1,2 In the present study, we hypothesized that even smaller dose would offer the desired analgesia effect in urologic surgery. Material and methods: After informed consent, 73 ASA I or II patients scheduled for either a nephrectomy or a peylotomy, were randomly allocated to one of two groups to receive either 0,1 mg morphine (group M10) or 0,05 mg morphine (group M5) in addition with 25 g fentanyl in their spinal anaesthetic. Intra-operatively, opioid requirements, blood pressure, heart rate and time for extubation were recorded. Post operatively, we assessed analgesic use in the recovery roum and in the ward, incidence and severity of side effects. We used Mann-Whitney and X2 tests for non parametric data and Student T and ANOVA tests for continuous data. P ⬍ 0,05 was significant. Results: Demographic data were similar in both groups. Fentanyl consumption, heamodynamic data and time for extubation did not differ between groups. Whoever, postoperative analgesic rescue during the recovery and in the first 6 hours was significantly lower in M10 group (0,1 mg): 6,6% vs 34,3%, p ⫽ 0,01 and 26, % vs 50%, p ⫽ 0,01). Side effects were rare in both groups. Conclusion: The dose of 0,1 mg of intrathecal morphine resulted in lower postoperative analgesic requirements than 0,05 mg with a minimal side effects.
References 1. Palmer G, et al. Anesthesiology. 1999;90:437-439. 2. Slappendel R, et al. Anaesth Analg. 1999;88:822-826.
41. Comparative study of two protocols of small-dose bupivacaine spinal anaesthesia for urologic surgery in elderly Kaabachi O Hoˆ pital Sahloul, Sousse, Tunisia Background and aim of the study: Spinal anaesthesia is associated with a risk of severe hypotension in elderly.1 The synergism between analgesic additives and local anaesthetics may make it possible to achieve reliable spinal anaesthesia with minimal side effects using a minidose of local anaesthetic.2 The purpose of investigation was to study the effect of small doses intrathecal clonidine and fentanyl on the spread and duration of low-dose hyperbaric bupivacaine spinal anaesthesia. Materials and methods: Seventy two patients, aged ⱖ 60 years, scheduled for trans bladder resection of prostate were randomly assigned to receive one of the following double-blinded hyperbaric intrathecal solutions: 7,5 mg of bupivacaine and 25 g fentanyl (groupA), 5 mg bupivacaine, 25 g fentanyl and 30 g clonidine (groupB). We recorded onset and peak level of sensory block, intensity of motor blockage, time to two-segment regression, number of hypotensive measurements, total vasopressor use and postoperative analgesic rescue. Statistic analysis used T test and ANOVA for continuous parameters and X2 and Fisher’s exact tests for parametric data; p ⬍ 0,05 was significant. Results: Demographic data were similar in both groups. Fourteen patients were excluded due to failed block (sensory block ⬍ T10) (group A 21% vs 17% group B; p ⫽ 0,5). There were no statically significant differences between groups regarding: level and duration of sensory block, intensity and duration of motor block, episodes of hypotension (group A 21% vs 12,5% group B; p ⫽ 0,47). Postoperative analgesic needs were significantly important in group B 68,7% vs 31,25% in group A; p ⫽ 0,02. Conclusion: In the present study, addition of small doses of fentanyl and clonidine to low-dose hyperbaric bupivacaine spinal anesthesia failed to provide complete anaesthesia in 21% of patients in group A (7,5 mg Bupivacaine) and 17% of patients in group B (5 mg bupivacine).
References 1. Rooke GA, et al. Anesth Analg. 1997;85:99-105. 2. Ben-David B, et al. Anaesthesiology. 2000;92:6-12.
Posters
•
Central Nerve Blocks I
39. Efficacy of low-dose intrathecal morphine in urologic surgery Kaabachi O Hoˆ pital Sahloul, Sousse, Tunisia Background and aim of the study: Low-dose of intrathecal morphine was associated with a prolonged and an effective analgesia. The dose of 0,1 mg was the optimal dose with minimal unpleasant side effects.1,2 In the present study, we hypothesized that even smaller dose would offer the desired analgesia effect in urologic surgery. Material and methods: After informed consent, 73 ASA I or II patients scheduled for either a nephrectomy or a peylotomy, were randomly allocated to one of two groups to receive either 0,1 mg morphine (group M10) or 0,05 mg morphine (group M5) in addition with 25 g fentanyl in their spinal anaesthetic. Intra-operatively, opioid requirements, blood pressure, heart rate and time for extubation were recorded. Post operatively, we assessed analgesic use in the recovery roum and in the ward, incidence and severity of side effects. We used Mann-Whitney and X2 tests for non parametric data and Student T and ANOVA tests for continuous data. P ⬍ 0,05 was significant. Results: Demographic data were similar in both groups. Fentanyl consumption, heamodynamic data and time for extubation did not differ between groups. Whoever, postoperative analgesic rescue during the recovery and in the first 6 hours was significantly lower in M10 group (0,1 mg): 6,6% vs 34,3%, p ⫽ 0,01 and 26, % vs 50%, p ⫽ 0,01). Side effects were rare in both groups. Conclusion: The dose of 0,1 mg of intrathecal morphine resulted in lower postoperative analgesic requirements than 0,05 mg with a minimal side effects.
References 1. Palmer G, et al. Anesthesiology. 1999;90:437-439. 2. Slappendel R, et al. Anaesth Analg. 1999;88:822-826.
41. Comparative study of two protocols of small-dose bupivacaine spinal anaesthesia for urologic surgery in elderly Kaabachi O Hoˆ pital Sahloul, Sousse, Tunisia Background and aim of the study: Spinal anaesthesia is associated with a risk of severe hypotension in elderly.1 The synergism between analgesic additives and local anaesthetics may make it possible to achieve reliable spinal anaesthesia with minimal side effects using a minidose of local anaesthetic.2 The purpose of investigation was to study the effect of small doses intrathecal clonidine and fentanyl on the spread and duration of low-dose hyperbaric bupivacaine spinal anaesthesia. Materials and methods: Seventy two patients, aged ⱖ 60 years, scheduled for trans bladder resection of prostate were randomly assigned to receive one of the following double-blinded hyperbaric intrathecal solutions: 7,5 mg of bupivacaine and 25 g fentanyl (groupA), 5 mg bupivacaine, 25 g fentanyl and 30 g clonidine (groupB). We recorded onset and peak level of sensory block, intensity of motor blockage, time to two-segment regression, number of hypotensive measurements, total vasopressor use and postoperative analgesic rescue. Statistic analysis used T test and ANOVA for continuous parameters and X2 and Fisher’s exact tests for parametric data; p ⬍ 0,05 was significant. Results: Demographic data were similar in both groups. Fourteen patients were excluded due to failed block (sensory block ⬍ T10) (group A 21% vs 17% group B; p ⫽ 0,5). There were no statically significant differences between groups regarding: level and duration of sensory block, intensity and duration of motor block, episodes of hypotension (group A 21% vs 12,5% group B; p ⫽ 0,47). Postoperative analgesic needs were significantly important in group B 68,7% vs 31,25% in group A; p ⫽ 0,02. Conclusion: In the present study, addition of small doses of fentanyl and clonidine to low-dose hyperbaric bupivacaine spinal anesthesia failed to provide complete anaesthesia in 21% of patients in group A (7,5 mg Bupivacaine) and 17% of patients in group B (5 mg bupivacine).
References 1. Rooke GA, et al. Anesth Analg. 1997;85:99-105. 2. Ben-David B, et al. Anaesthesiology. 2000;92:6-12.