Comparative Analysis of the Impact of Continuous Spinal Anesthesia and Single-Dose Spinal Anesthesia Techniques On Hemodynamics, Sensory And Motor Block Levels In Transurethral Surgery Cases

Yıl 2023, Cilt: 7 Sayı: 3, 274 - 284, 31.12.2023

Mehmet Mert Tuna

https://doi.org/10.30565/medalanya.1401259

Öz

Aim: In this study, it was aimed to compare in patients undergoing transurethral resection surgery: 1- The effectiveness of single-dose and continuous spinal anesthesia techniques, 2- Hemodynamic changes, sensory-motor block levels and durations, anesthetic drug doses and side effects.

Method: Forty American Society of Anesthesiology I–III patients in the age group of 40–75 years who were scheduled for transurethral surgery were randomly divided into two groups: single dose spinal anesthesia (Group 1) (n = 20) and continuous spinal anesthesia (Group 2) (n = 20). The patients' hemodynamic data, analgesia status and motor block levels were evaluated.

Results: With regard to the hemodynamic parameters, the mean values of systolic–diastolic blood pressure and heart rate were found to be significantly lower in the single dose spinal anesthesia group (Group 1) than in the continuous spinal anesthesia group (p < 0.05). In terms of sensory and motor block levels, the maximum block level was T9 in the continuous spinal anesthesia group, while it was T8 in the single dose spinal anesthesia group (p < 0.05). Upon reaching T10, two-segment regression and sensory and motor block termination times were found to be significantly lower in the continuous spinal anesthesia group when compared to the single dose spinal anesthesia group (p < 0.05). There was no difference between the two groups in terms of Bromage score values (p > 0.05). In the continuous spinal anesthesia group, the mean dose and volume of the local anesthetic required to achieve analgesia in the T10 dermatome were found to be 7.12 ± 1.46 ml and 1.4 ± 0.29, respectively. Furthermore, the amount of fluid administered intraoperatively was found to be significantly lower in the continuous spinal anesthesia group than in the single dose group (p < 0.05).

Conclusion: With the continuous spinal anesthesia method, it can be titrated and by using lower doses of local anesthetic, a level of sensory-motor blockade close to the single-dose spinal anesthesia method and a more stable hemodynamics can be achieved.

Anahtar Kelimeler

Continius spinal anestesia, Single dose spinal anestesia, Transuretral surgery

Transüretral Cerrahi Vakalarinda, Sürekli Spinal ve Tek Doz Spinal Anestezi Tekniklerinin Hemodinami, Duyusal ve Motor Blok Seviyesi Üzerine Etkilerinin Karşilaştirilmasi

Öz

Amaç: Bu çalışmada transüretral rezeksiyon cerrahi yapılacak hastalarda: 1- Tek doz ve sürekli spinal anestezi tekniklerinin etkinliğinin 2- Hastalardaki hemodinamik değişikliklerin, duyu-motor blok düzeylerinin ve sürelerinin, anestezik ilaç dozlarının ve yan etkilerin karşılaştırılması amaçlanmıştır.

Yöntem: Transüretral cerrahi planlanan 40-75 yaş arası ASA I-III grubu 40 hasta tek doz spinal anestezi (Grup 1) (n=20) ve sürekli spinal anestezi (Grup 2) (n=20) olarak rastgele iki gruba ayrıldı. Hastaların hemodinamik verileri, analjezi durumları ve motor blok seviyeleri değerlendirildi.

Bulgular: Hemodinamik parametreler açısından, uygulama öncesine göre tek doz spinal anestezi grubu (grup 1) sistolik-diastolik kan basıncı ve kalp hızı ortalama değerleri sürekli spinal anestezi grubuna göre anlamlı olarak düşük bulundu (p<0,05). Duyusal ve motor blok seviyelerine bakıldığında; tek doz spinal anestezi grubunda maksimum blok seviyesi T8 iken sürekli spinal anestezi grubunda T9 olarak bulundu (p<0,05). T10 ‘a ulaşma, iki segment gerileme, duyusal ve motor blok sonlanma zamanları sürekli spinal anestezi grubunda, tek doz spinal anestezi grubuna göre anlamlı olarak düşük bulundu (p<0,05). Her iki grup arası bromage skor değerleri açısından fark yoktu (p>0,05). Sürekli spinal anestezi grubunda, T10 dermatomunda analjezi sağlamak için gerekli olan lokal anestezik dozu ortalama 7,12±1,46 ml, hacmi ise 1,4±0,29 olarak bulundu. Yine intraoperatif verilen sıvı miktarı, sürekli spinal anestezi grubunda anlamlı olarak düşük bulundu (p<0,05).

Sonuç: Sürekli spinal anestezi yöntemiyle, titre edilebilir ve daha az dozda lokal anestezik kullanılarak, tek doz spinal anestezi yöntemine yakın bir duyusal-motor blok seviyesi ve daha stabil bir hemodinami sağlanabilir.

Anahtar Kelimeler

Sürekli spinal anestezi, Tek doz spinal anestezi, Transüretral cerrahi

Kaynakça

• 1. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015 Jun;67(6):1066-1096. doi: 10.1016/j.eururo.2014.06.017.
• 2. Sergin DY, Erhan E, Özyar B, Dizdar GU, Yeğül İ. Açık Prostatektomi Ameliyatı Geçirecek Hastalarda Tek Doz Spinal Anestezi ve Sürekli Spinal Anestezi Tekniklerinin Karşılaştırılması. Klinik Tıp Bilimleri Dergisi, 201;6(2):17-24. https://dergipark.org.tr/tr/download/article-file/776077
• 3. Marşan A, Kırdemir P, Urfalıoğlu A, Göğüş N. Alt ekstremite girişimlerinde, iki rejyonel anestezi tekniğinin analjezi ve hemodinamik etkilerinin karşılaştırılması. Anestezi Dergisi 2005;13(4):253-257. https://www.acarindex.com/pdfs/405205
• 4. Aydın ŞP, Bozkırlı F. Transüretral Rezeksiyonda Tek Doz Ve Sürekli Subaraknoid Levobupivakain Uygulamasının Karşılaştırılması. Turkish Journal of Geriatrics 2014; 17 (4) 366-372. https://geriatri.dergisi.org/uploads/pdf/pdf_TJG_848.pdf
• 5. Üstüner A, Özyuvacı E, Toprak N, Eren N. Total Kalça Protezi Uygulanan Hastalarda Sürekli ve Tek Doz Spinal Anestezi Yöntemlerinin Karşılaştırılması. Istanbul Tıp Dergisi 2007:1;7-10. https://cms.istanbulmedicaljournal.org/Uploads/Article_20946/IMJ-8-7-En.pdf
• 6. Thomas, J.M., Schug, S.A. Recent Advances in the Pharmacokinetics of Local Anaesthetics. Clin Pharmacokinet 36, 67–83 (1999). https://doi.org/10.2165/00003088-199936010-00005
• 7. Kırdemir P, Solmaz FA. Enhanced Recovery After Surgery (ERAS) and Anesthesia. Acta Med. Alanya 2020;4(1):95-101. doi:10.30565/medalanya.587027
• 8. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000 Mar;59(3):551-79. doi: 10.2165/00003495-200059030-00013.
• 9. McLeod GA, Burke D. Levobupivacaine. Anaesthesia. 2001 Apr;56(4):331-41. doi: 10.1046/j.1365-2044.2001.01964.x.
• 10. Maurer K, Bonvini JM, Ekatodramis G, Serena S, Borgeat A. Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip arthroplasty. Acta Anaesthesiol Scand. 2003 Aug;47(7):878-83. doi: 10.1034/j.1399-6576.2003.00173.x.
• 11. Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoïpé M, Lassié P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg. 1996 Feb;82(2):312-6. doi: 10.1097/00000539-199602000-00017.
• 12. Minville V, Fourcade O, Grousset D, Chassery C, Nguyen L, Asehnoune K, Colombani A, Goulmamine L, Samii K. Spinal anesthesia using single injection small-dose bupivacaine versus continuous catheter injection techniques for surgical repair of hip fracture in elderly patients. Anesth Analg. 2006 May;102(5):1559-63. doi: 10.1213/01.ane.0000218421.18723.cf.
• 13. Baydilek Y, Yurtlu BS, Hanci V, Ayoğlu H, Okyay RD, Kayhan GE, Tokgöz H, Mungan G, Ozkoçak I. The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery. Braz J Anesthesiol. 2014;64(2):89-97. doi: 10.1016/j.bjane.2013.03.007
• 14. Mohamed SA, Hussam AM, Abdallah SA, Sarhan KA, Shaban AM. Ondansetron Is an Effective Alternative to Decrease the Incidence of Postspinal Hypotension in Healthy Subjects Undergoing Infra-Umbilical Surgeries Compared To Combined Volume Loading and Vasoconstrictors: Randomized Controlled Trial. Open Access Maced J Med Sci. 2018;6(12):2363-2368. doi: 10.3889/oamjms.2018.491.
• 15. Gratadour P, Viale JP, Parlow J, Sagnard P, Counioux H, Bagou G, Annat G, Hughson R, Quintin L. Sympathovagal effects of spinal anesthesia assessed by the spontaneous cardiac baroreflex. Anesthesiology. 1997 Dec;87(6):1359-67. doi: 10.1097/00000542-199712000-00015.
• 16. Kaur M, Katyal S, Kathuria S, Singh P. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery. Saudi J Anaesth. 2011 Apr;5(2):202-7. doi: 10.4103/1658-354X.82804.
• 17. de Andrés J, Bellver J, Bolinches R. Comparison of continuous spinal anaesthesia using a 32-gauge catheter with anaesthesia using a single-dose 24-gauge atraumatic needle in young patients. Br J Anaesth. 1994 Dec;73(6):747-50. doi: 10.1093/bja/73.6.747.
• 18. Velickovic IA, Leicht CH. Continuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy. Int J Obstet Anesth. 2004 Jan;13(1):40-3. doi: 10.1016/S0959-289X(03)00052-9.
• 19. Van Gessel EF, Praplan J, Fuchs T, Forster A, Gamulin Z. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg. 1993 Sep;77(3):483-7. doi: 10.1213/00000539-199309000-00011.
• 20. Schnider TW, Mueller-Duysing S, Jöhr M, Gerber H. Incremental dosing versus single-dose spinal anesthesia and hemodynamic stability. Anesth Analg. 1993 Dec;77(6):1174-8. doi: 10.1213/00000539-199312000-00016.
• 21. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin. 1989 Spring;27(1):31-9. doi: 10.1097/00004311-198902710-00007.
• 22. Lundorff L, Dich-Nielsen JO, Laugesen H, Jensen MM. Single-dose spinal anaesthesia versus incremental dosing for lower limb vascular surgery. Acta Anaesthesiol Scand. 1999 Apr;43(4):405-10. doi: 10.1034/j.1399-6576.1999.430407.x.
• 23. Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin. 1989 Spring;27(1):31-9. doi: 10.1097/00004311-198902710-00007.
• 24. Pitkänen M, Rosenberg P, Silvanto M, Tuominen M. Haemodynamic changes during spinal anaesthesia with slow continuous infusion or single dose of plain bupivacaine. Acta Anaesthesiol Scand. 1992 Aug;36(6):526-9. doi: 10.1111/j.1399-6576.1992.tb03512.x.
• 25. Reisli R, Horasanlı E, Demirbilek S, Dikmen B, Yiğitbaşı B, Göğüş N. Tek doz ve sürekli spinal anestezinin hemodinamik ve anestezik etkilerinin karşılaştırılması. Türk Anest Rean Cem Mecmuası 1999; 27:21-26.
• 26. Minville V, Asehnoune K, Delussy A, Fourcade O, Colombani A, Rabinowitz A, Samii K. Hypotension during surgery for femoral neck fracture in elderly patients: effect of anaesthetic techniques. A retrospective study. Minerva Anestesiol. 2008 Dec;74(12):691-6. PMID: 19034248.
• 27. Hewson DW, Bedforth NM, Hardman JG. Spinal cord injury arising in anaesthesia practice. Anaesthesia. 2018 Jan;73 Suppl 1:43-50. doi: 10.1111/anae.14139.
• 28. Mahisekar UL, Winnie AP, Vasireddy AR, Masters RW. Continuous spinal anesthesia and post dural puncture headache: a retrospective study. Reg Anesth. 1991 Mar-Apr;16(2):107-11. PMID: 2043523.
• 29. Liu N, Montefiore A, Kermarec N, Rauss A, Bonnet F. Prolonged placement of spinal catheters does not prevent postdural puncture headache. Reg Anesth. 1993 Mar-Apr;18(2):110-3. PMID: 8489976.
• 30. Faccenda KA, Finucane BT. Complications of regional anaesthesia Incidence and prevention. Drug Saf. 2001;24(6):413-42. doi: 10.2165/00002018-200124060-00002.
• 31. Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992 Jun;76(6):906-16. doi: 10.1097/00000542-199206000-00006.
• 32. Kim NY, Kim SY, Ju HM, Kil HK. Selective spinal anesthesia using 1 mg of bupivacaine with opioid in elderly patients for transurethral resection of prostate. Yonsei Med J. 2015 Mar;56(2):535-42. doi: 10.3349/ymj.2015.56.2.535.
• 33. Calis H, Aslan A. What is gray literature and how to search for it. Acta Med. Alanya 2020;4(2):111-112. doi:10.30565/medalanya.707584