Neuroaxial anesthesia for lower limbs peripheral vascular disease reconstructive surgeries
DOI:
https://doi.org/10.14739/2310-1237.2025.1.317706Keywords:
anesthesia, anesthetic complications, anesthetic effect, combined spinal-epidural anesthesia, pain management, spinal anesthesia, lower limb, peripheral artery diseaseAbstract
Combined spinal-epidural anesthesia (CSEA) is an effective approach that combines the advantages of both spinal and epidural anesthesia into a single technique. This method is particularly beneficial for patients who have undergone lower extremity surgery and require additional anesthesia, with the ability to administer epidural anesthetics both during the surgery and in the early postoperative period.
The aim of the study was to compare the effectiveness of different methods of anesthetic support during reconstructive surgery for atherosclerosis obliterans of the lower extremities.
Methods and materials. We compared the effectiveness of spinal anesthesia (SA) without the use of adjuvants and CSEA in order to determine the optimal approach to achieve better anesthesia, analgesic effect, and reduce postoperative complications. A total of 60 patients, aged 65.61 ± 7.36 years, with indications for reconstructive surgery due to for peripheral artery disease of the lower limbs and classified as ASA III–IV, participated in the study. The SA group (30 patients) received a 0.5 % hyperbaric bupivacaine solution (3 ml) without an adjunct, while the CSEA group (30 patients) received a 0.5 % hyperbaric bupivacaine hydrochloride solution (15 mg, 3 ml). Epidural anesthesia – test dose of 0.25 % isobaric bupivacaine hydrochloride solution (12.5 mg), followed by the administration of 0.25 % isobaric bupivacaine hydrochloride solution (20 mg) through the epidural catheter 3 hours after the start of the surgery. The duration of analgesia, onset and regression times of sensory and motor blockade, VAS scores, and any side effects were evaluated and recorded.
Results. The duration of analgesia was significantly prolonged in the CSEA group (437.05 ± 43.36 minutes) compared to the SA group (238.33 ± 32.27 minutes; p < 0.0801). The onset of sensory and motor blockade did not show significant differences between the groups. The VAS scores were lower in the CSEA group throughout the 48 hours postoperatively. The SA group experienced a higher incidence of postoperative nausea and vomiting, as well as tremors. In contrast, the CSEA group had a higher incidence of hypotension and urinary retention. Respiratory depression was not observed in either group.
Conclusions. CSEA is a superior alternative to both epidural blockade and spinal anesthesia, combining the benefits of both techniques while minimizing their side effects. CSEA reduces the required doses of local anesthetics compared to epidural anesthesia to achieve the desired level of blockade. Additionally, CSEA provides better perioperative analgesia than spinal anesthesia.
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