Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T08:41:18.639Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of patient posture during puncture on successful unilateral spinal anaesthesia in outpatient lower abdominal surgery

Published online by Cambridge University Press:  01 March 2006

M. Al Malyan ,
C. Becchi ,
S. Falsini ,
P. Lorenzi ,
V. Boddi ,
M. Marsili  and
S. Boncinelli
M. Al Malyan
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
C. Becchi
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
S. Falsini
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
P. Lorenzi
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
V. Boddi
Affiliation:
Florence University, Department of Public Health, Italy
M. Marsili
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
S. Boncinelli
Affiliation:
Florence University, Department of Medical and Surgical Critical Care, Section of Anaesthesia and Intensive Care, Italy
Get access

Extract

Summary

Background and objective: Unilateral spinal anaesthesia is a useful anaesthesia technique in lower abdominal surgery, especially in an outpatient setting. Patient posture is pivotal in the achievement of unilateral anaesthesia. Nevertheless, no studies have elucidated the influence of patient posture during the anaesthetic injection on unilaterality. Thus, the aim was to compare the effect of patient posture, during the induction phase of spinal anaesthesia, on block characteristics. Methods: Eighty patients, ASA I–II, scheduled for unilateral hernioplasty were randomized into two groups. Anaesthesia was performed in lateral position in Group 1 (G1) with operative side down and in sitting position in Group 2 (G2) whose patients were then immediately turned on their lateral side. All patients were maintained for 20 min in lateral position with their operative side down. Hyperbaric bupivacaine 1% 10 mg were used. Results: Unilateral anaesthesia was seen in 80% (32/40) and 12.5% (5/40) of G1 and G2, respectively. The readiness for surgery was faster in G1 (P < 0.0001). The motor block in the non-operative side was stronger in G2 (P < 0.0001). The offset of sensory block was faster in G1 (P = 0.0001). The offset of motor block was slower in G1 (P = 0.0008). The time for voiding was shorter in G1, although not significant. Conclusions: Lateral posture during the induction of spinal anaesthesia is pivotal for a higher success of unilateral block, a fast readiness to surgery, and a fast recovery. Therefore, this technique can be considered feasible and time-saving for lower abdominal surgery.

Keywords

ANAESTHETIC TECHNIQUES, spinalANAESTHESIA SPINAL, unilateralANAESTHETICS LOCAL, bupivacaine, hyperbaricAMBULATORY SURGICAL PROCEDURESPOSTURE, lateral, sitting
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 6 , June 2006 , pp. 491 - 495
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. Anesth Analg 2000; 91: 876–881.Google Scholar
Sultana A, Jagdish S, Pai D, Rajendiran KM. Inguinal herniorrhaphy under local anaesthesia and spinal anaesthesia – a comparative study. J Indian Med Assoc 1999; 97: 169–170.Google Scholar
Casati A, Fanelli G, Aldegheri G et al. Frequency of hypotension during conventional or asymmetric hyperbaric spinal block. Reg Anesth Pain Med 1999; 24: 214–219.Google Scholar
Fanelli G, Borghi B, Casati A, Bertini L, Montebugnoli M, Torri G. Unilateral bupivacaine spinal anesthesia for outpatient knee arthroscopy. Can J Anaesth 2000; 47: 746–751.Google Scholar
Liu SS, Ware PD, Allen HW, Neal JM, Pollock JE. Dose-response characteristics of spinal bupivacaine in volunteers. Clinical implications for ambulatory anesthesia. Anesthesiology 1996; 85: 729–736.Google Scholar
Casati A, Fanelli G, Cappelleri GL et al. Effects of spinal needle type on lateral distribution of 0.5% hyperbaric bupivacaine: a double blind study. Anesth Analg 1998; 87: 355–359.Google Scholar
Kuusniemi KS, Phihlajamaki KK, Pitkanen MT. A low dose of plain or hyperbaric bupivacaine for unilateral spinal anesthesia. Reg Anesth Pain Med 2000; 25: 605–610.Google Scholar
Povey HMR, Olsen PA, Pihl H. Spinal analgesia with hyperbaric 0.5% bupivacaine effects of different patient positions. Acta Anaesthesiol Scand 1987; 31: 616–619.Google Scholar
Povey HMR, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5% bupivacaine: effect of a 60-min period of sitting. Acta Anaesthesiol Scand 1989; 33: 295–297.Google Scholar
Wildsmith JA, McClure JH, Brown DT, Scott DB. Effects of posture on the spread of isobaric and hyperbaric amethocaine. Br J Anaesth 1981; 53: 273–278.Google Scholar
Martin-Salvaj G, Van Gessel E, Forster A, Schweizer A, Iselin-Chaves I, Gamulin Z. Influence of duration of lateral decubitus on the spread of hyperbaric tetracaine during spinal anaesthesia: a prospective time-response study. Anesth Analg 1994; 79: 1107–1112.Google Scholar
Sumi M, Sakura S, Koshizaki M, Saito Y, Kosaka Y. The advantages of the lateral decubitus position after spinal anaesthesia with hyperbaric tetracaine. Anesth Analg 1998; 87: 879–884.Google Scholar
World Medical Association. Ethical principles for medical research involving human subjects. Eur J Emerg Med 2001; 8: 221–224.
Bromage PR, Burfort MF, Crowell DE, Pettigrew RT. Quality of epidural blockade. I. Influence of physical factors. Br J Anaesth 1964; 36: 342–352.Google Scholar
Chung F. Discharge criteria – a new trend. Can J Anaesth 1995; 42: 1056–1058.Google Scholar
Mulroy MF, Salinas FV, Larkin KL, Polissar NL. Ambulatory surgery patients may be discharged before voiding after short-acting spinal and epidural anesthesia. Anesthesiology 2002; 97: 315–319.Google Scholar
Frank A, Schuster M, Biscoping J. Influence of positioning on the quality of unilateral spinal anesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther 2002; 37: 659–664.Google Scholar
Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Volmanen P, Korttila K. Influence of the injection site (L2/3 or L3/4) and the posture of the vertebral column on selective spinal anaesthesia for ambulatory knee arthroscopy. Acta Anaesthesiol Scand 2005; 49: 72–77.Google Scholar
Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron GP. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg 1995; 81: 73–79.Google Scholar
Axelsson KH, Edstrom HH, Sundberg AEA, Widman GB. Spinal anaesthesia with hyperbaric 0.5% bupivacaine: effect of volume. Acta Anaesthesiol Scand 1982; 26: 439–445.Google Scholar
Niemi L, Tuominen M, Pitkanen M, Rosenberg PH. Effect of late posture change on the level of spinal anaesthesia with plain bupivacaine. Brit J Anaest 1993; 71: 807–809.Google Scholar
Esmaoglou A, Boyaci A, Ersoy O, Guler G, Talo R, Tercan E. Unilateral spinal anesthesia with hyperbaric bupivacaine. Acta Anaesthesiol Scand 1998; 42: 1083–1087.Google Scholar
Greene NM. Uptake and elimination of local anesthetics during spinal anesthesia. Anesth Analg 1983; 62: 1013–1024.Google Scholar
Moriarty T, Ely J. Neuraxial blockade in children. Anaesthesia and intensive care medicine 2003; 4: 412–419.Google Scholar
Pfung AE, Aashiem GM, Foster C. Sequence of return of neurological function and criteria for safe ambulation following subarachnoid block. Can J Anesth Soc J 1978; 25: 133.Google Scholar